LOCAL ENHANCED SERVICE

EL2:NEEDLE & SYRINGE EXCHANGE SERVICE

SERVICE LEVEL AGREEMENT 2010-11

PLEASE INSERT PHARMACY STAMP HERE (if available)

CONTENTS

  • Details of Agreement
  • Financial Details
  • Service Description
  • Service Aims and Intended Outcomes
  • Service Outline
  • Ongoing Measurement & Evaluation
  • Sources of Further Information
  • Signatories to Agreement

APPENDICES

  • 1 – Equipment and Materials to be Provided
  • 2 – Client Registration Form
  • 3 – Referral Points and Contacts
  • 4 – Claim Form


DETAILS OF AGREEMENT

Parties to Agreement

This Agreement is made between;

Hull Teaching Primary Care Trust (NHS Hull) on behalf of the One Hull Community Safety Partnership at 3rd Floor, Kingston House, Bond Street, Hull, HU1 3ER (“the Purchaser”); and

XXXXXX Pharmacy at address etc, (“the Pharmacy Contractor”)

Commencement and Duration

1.This Agreement commences on 1st April 2010 and will end on 31stMarch 2011. The Agreement will be reviewed on an annual basis and will be subject to renewal if agreed by both parties.

2.This Agreement may be terminated without penalty, if the Purchaser or the Pharmacy Contractor gives the other party at least three month’s notice in writing.

3.The Purchaser reserves the right to withdraw this enhanced service immediately if the pharmacy is found not to be meeting its requirements for the provision of essential services after the SLA has commenced.

Provision of Enhanced Services

This enhanced service will only be commissioned from pharmacies that provide the full range of Essential Services as defined by the Pharmacy Contract.

Financial Details

Set Up Cost (per pharmacy) £500

Fee per Transaction £1.40 plus VAT @17.5%

The set up costis a one off payment to enable contractors to participate in this enhanced service by enabling them to make any necessary alterations to premises (to ensure service user privacy and safety) and to implement any necessary administrative processes.

Payment Terms

Financial Claims and Suplement Sheets for this service should be sent on a monthly basis, by the 9th of each following month to:

Sue Kitching, Finance Dept, Health House, Grange Park Lane, Willerby,

Hull,HU10 6DT; and also posted or emailed to

Andy Major, Performance Analyst, NHS Hull, c/o Hull Citysafe, 3rd Floor, Kingston House, Bond Street, Hull, HU1 .

SERVICE DESCRIPTION

1.The needle exchange service is a level 2 service as defined in “Needle and syringe programmes: providing people who inject drugs with injecting equipment” NICE public health guidance 18. A level 2 service is required to distribute “pick and mix” (bespoke) injecting equipment plus health promotion advice (including advice and information on how to reduce the harms caused by injecting drugs).

2.Pharmacies will provide access to sterile needles and syringes, and sharps containers for return of used equipment. Associated materials, for example swabs, will also be provided to promote safe injecting practice and reduce transmission of infections by substance misusers.

3.Pharmacies will offer a user-friendly, non-judgmental, client-centred and confidential service.

4. Used equipment should normally be returned by the service user to the Pharmacy for safe disposal.The Pharmacy will not continue to dispense equipment to service users who consistently fail to return used equipment. The Pharmacy will provide a service for the safe disposal of used equipment and promote the use of this service.

5.The service user will be provided with appropriate health promotion materials.

6.The pharmacy will provide support and advice to the user, including referral to other health and social care professionals and specialist drug (including those providing opioid substitution therapy) and alcohol treatment services where appropriate.

7. The pharmacy will promote safe practice to the user, including advice on sexual health and STIs, HIV and Hepatitis C transmission and Hepatitis B immunisation.

SERVICE AIMS and INTENDED OUTCOMES

  1. 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.
  1. To protect health and reduce the rate of blood-borne infections and drug related deaths among service users by:

2.1reducing the rate of sharing equipment by encouraging needle identification schemes and reducing the rate of other high risk injecting behaviours;

2.2providing sterile injecting equipment and other support;

2.3promoting safer injecting practices, particularly when dispensing long needles and other equipment that could be in more dangerous practices; and

2.4providing and reinforcing harm reduction messages including safe sex advice and advice on overdose prevention (e.g. risks of poly-drug use and alcohol use).

  1. To improve the health of local communities by preventing the spread of blood-borne infections by ensuring the safe disposal of used injecting equipment by providing users with sharps containers and advice on how to dispose of needles and syringes safely.
  1. To help service user’s access treatment by offering referral to specialist drug (including those providing opioid substitution therapy) and alcohol treatment centres and health and social care professionals where appropriate.
  1. To aim to maximise the access and retention of all injectors, especially the highly socially excluded.
  1. 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).
  1. To increase the proportion of service users who have over 100% coverage of sterile needles and syringes i.e. more than one sterile needle and syringe for every injection.

SERVICE OUTLINE

The Enhanced Service

  1. This enhanced service must be provided throughout the pharmacy’s contracted hours although it is recognised that some restriction at the beginning or end of the day may be necessary.
  1. The 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.The pharmacy will allocate a safe place to store equipment and returns for safe onward disposal. The storage containers provided by the Purchasers commissioned clinical waste disposal service will be used to store returned used equipment.

4.Appropriate protective equipment, including gloves, overalls and materials to deal with spillages, should be readily available close to the storage site.

5. The pharmacy should clearly display the national scheme logo or a local logo indicating participation in the service.

6. The Pharmacy will provide a range of needles and syringes (dependent upon the needs of the service user) and associated materials.The range of materials that can be provided are contained in Appendix 1. The Purchaser will not fund any materials or equipment not within Appendix 1.

7.The Purchaserwill commission a clinical waste disposal service for each participating pharmacy. The frequency of waste collection should be agreed to ensure there is not an unacceptable build up of clinical waste on the pharmacy premises.

8.Pharmacies will only order equipment from the Purchaser approved supplier which is the NHS Supply Chain. The NHS Supply Chain will invoice the Purchaser directly for all equipment and materials supplied to Pharmacies.

9. Pharmacies can order required leaflets from either the Harm Reductions Works website or from the Purchaser – see paragraph 10. below.

10.The pharmacy will register, whenever possible, new clients utilising the Client Registration Form provided at Appendix 2.

11. All new clients will be given a new client information pack that will contain as a minimum literature onaccessing structured drugs treatment, Hepatitis B and C, Safer Injecting and Overdose Prevention.

The following materials can be obtained, free of charge, from the Ordering section ofthe “Harm Reduction Works” website :

Hep C – A Handbook ref HRPUB1

Hep B Information / Vaccination ref HRleaflet2

Injecting and Infections ref HRPUB4

Safer Injecting ref HRDVD5

Overdose … Everything You Need to know ref HRDVD6

The following materials can be ordered, free of charge, directly from the Purchaser :

Recovery Leaflet – accessing drug treatment

8 ways to help stay safe

Please contact Anna Pilgrim on 612816 when ordering.

Staffing

1.The pharmacy contractor has a duty to ensure that pharmacists and all other staff involved in the provision of the service have relevant knowledge and are appropriately trained in the operation of the service.

2.The pharmacy contractor has a duty to ensure that pharmacists and staff involved in the provision of the service are aware of and operate within local protocols.

3. The pharmacy contractor should ensure that their staff 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.

4.Staff involved in the delivery of this service should be offered immunisation for Hepatitis B or have signed a declaration declining vaccination. An Inoculation Accidents leaflets should be made available to all staff involved in the service delivery (including locums).

5. The Purchaser will provide details of relevant referral points which pharmacy staff can use to signpost service users who require further assistance.Relevant referral points are detailed in Appendix 3.

6.The Pharmacy Contractor will obtain health promotion material relevant to the service users and ensure this is available in pharmacies – as a minimum the materials listed in The Enhanced Service paragraph 11 above should be available.

7.All pharmacists providing this service will complete the CPPE Open Learning Programme entitled “Substance Use and Misuse” A copy of their certificate of completion will be held in the pharmacy.

8.The Compass Outreach service will visit participating pharmacies (3-monthly) to promote service development and update the general knowledge of pharmacy staff on local issues.

9.Pharmacy staff will contact the Compass Outreach service with any urgent service user’s queries. The Outreach Service point of contact is Peta Godney, 01482 221551.

10. TheCompass Outreach service will offer pharmacy staff the following training:

  • Detailed Drug Awareness – duration 3 hours – providing a comprehensive overview of the signs, symptoms and effects of specific drugs enabling participants to respond to the needs of service users. Overview of Hull Drug Treatment system also included.
  • Basic Life Support and Overdose Prevention – duration 2 hours – aimed at those who come into contact with illicit drug users who may be at risk of drugs overdose.
  • Harm Reduction – duration 3 hours – to improve knowledge and understanding and ability in assessment of risk. Participants will also gain the skills necessary to provide harm reduction advice and support to service users.
  • Hepatitis Training – duration 1 hour – to improve knowledge and understanding regarding Hepatitis treatment and screening.

A least one member of staff, from each pharmacy will be expected to attend this training on a yearly basis. Training dates will be agreed on an annual basis.

Records / Audit

1.The pharmacy should maintain appropriate records to ensure effective ongoing service delivery and audit. The pharmacy will be expected to undertake an annual review, on a rolling basis, with each service user to ensure registration details held for each service user are up to date and accurate.

2.Pharmacists will share relevant information with other health care professionals and agencies, in line with locally determined confidentiality arrangements.

3. The Purchaser will provide a claim formfor the recording of relevant service information for the purposes of audit and the claiming of payment.

4.The Pharmacy will have reviewed and considered Harm Minimisation Guidance.

5. Pharmacists will record relevant service information for the purposes of audit using the framework provided the Purchaser.

6.The Pharmacy will comply with the requirements of the Needle Exchange Monitoring System (NEXMS). Compliance to this system will be ensured by full completion of the Claim Document at Appendix 4.

7. The pharmacy participates in an annual audit of the service requested by the Purchaser in liaison with the LPC. The results of this audit are reviewed by the Purchaser annually.

8. The pharmacy regularly reviews the Code of Ethics and accompanying practice guidance (ref: )

Quality

1.The Purchaser should arrange at least one pharmacy contractor meeting per year to promote service development and update the knowledge of pharmacy staff.

2.The pharmacy has appropriate health promotion material available for the user group and promotes its uptake. Materials are free of charge from Harm Reduction Works.

3. The pharmacy reviews its standard operating procedures and the referral pathways for the service on an annual basis.

4.The pharmacy can demonstrate that pharmacists and staff involved in the provision of the service have undertaken CPD relevant to this service.

5. The pharmacy can demonstrate that the rate of return of used equipment meets locally agreed targets.

6. The pharmacy participates in an annual Purchaser organised audit of service provisionin liaison with the LPC.

7. The pharmacy co-operates with any locally agreed Purchaser-led assessment of service user experience.

ONGOING MEASUREMENT AND EVALUATION

  1. The pharmacy is required to agree with the PCT/DAT this service specification/plan at the start of the year.
  1. The specific data measurement, evaluation and audit requirements of the scheme are outlined in the individual sections of this document
  1. The pharmacy will be required to collate the necessary evidence of compliance with the requirements of the scheme.
  1. The scheme will then be evaluated at the annual contract review with the PCT/DAT.

SOURCES OF FURTHER INFORMATION

Guidance on pharmaceutical services for drug misusers in England has been published by the National Treatment Agency for Substance Misuse (NTA), the Royal Pharmaceutical Society and the Pharmaceutical Services Negotiating Committee. The guidance entitled "Best practice guidance for commissioners and providers of pharmaceutical services to drug users" is available to download from the Society’s website at Pharmacy needle exchange services are discussed in detail within this document.

The National Institute for Health and Clinical Excellence (NICE) formal guidance on the optimal provision of needle and syringe programmes (NSPs) has been published as NICE public health guidance 18. The guidance titled “Needle and syringe programmes: providing people who inject drugs with injecting equipment” can be downloaded from the NICE website at

The Department for Environment, Food and Rural Affairs (DEFRA) has published further guidance on the disposal of needles and syringes. The guidance can be accessed via the following link Defra, UK - Environmental Protection - Local Environmental Quality - Litter

SIGNATORIES TO AGREEMENT

EL2: NEEDLE & SYRINGE EXCHANGE SERVICE (2010-11)

This document constitutes the agreement between the Purchaser and the Pharmacy Contractor in regards to this enhanced service.

Signature on behalf of the Pharmacy Contractor:

On behalf of the pharmacy I confirm that the information detailed within this service level agreement is accurate and reflects how the pharmacy approaches the provision of this service. In addition I confirm that the pharmacy will comply with the data reporting and audit requirements of the scheme.

Signature / Name / Date
Address:

Signature on behalf of the Purchaser:

Signature / Name / Date

PAYMENT WILL ONLY BE MADE UPON RECEIPT OF PHARMACY SIGNATURE SHEET

Pharmacy: Please keep a copy for your pharmacy records.

APPENDIX 1

Equipment and Materials to be Provided – subject to client need

Description / NHS Supply Chain Code
1ml Fixed Head Syringe Ins 29g x 12.7mm 324 / FWD038
2ml Barrel Syringe Hypo L/Slip 300185 / FWC000
Needle Heads Brown (26g x 5/8” / 0.4mm x 13mm) / FTR262
Needle Heads Orange (25g x 5/8” / 0.5mm x 16mm) / FTR140
Needle Heads Orange (25g x 1” / 0.5mm x 25mm) / FTR095
Needle Heads Blue (23g x 1” / 0.6mm x 25mm) / FTR052
Needle Heads Blue (23g x 1,25” / 0.6mm x 32mm) / FTR053
Needle Heads Green (21g x 1.5” / 0.8mm x 40mm) / FTR045
Needle Heads Green (21g x 2” / 0.8mm x 50mm) / FTR615
Service User Sharps Containers 1 litre / 2 litre / FSL078 / FSL 426
Swabs (1 per syringe)

Equipment and materials not on this list will not be paid for by the Purchaser. Requests for additional equipment and materials to be added onto this list must be made directly to the Purchaser.