County Durham & Darlington Priority Services Nhs Trust

BRADFORD NEEDLE EXCHANGE SCHEME

PHARMACY SERVICE LEVEL AGREEMENT

This service specification relates to the participation of pharmacies in the Bradford Needle Exchange Scheme. This includes the provision of sterile equipment, the safe disposal of used equipment and the on-going support for the providers and users of services.

The overall aim of syringe and exchange services will be to reduce the rates of equipment sharing amongst injecting drug users thereby preventing the risks of infection and drug related harm (individual and community).

To encourage pharmaceutical contractors to distribute clean injecting equipment, to provide advice and information on the safe disposal of injecting equipment, distribute appropriate literature advising harm reduction, safer sex and local services to injecting drug users.

To open up access to service provision for injecting drug users who are unknown to agencies for whatever reason.

To reduce the chance of used and contaminated injecting equipment falling into the hands of others by offering safe disposal.

To provide training and support to participating pharmacists and associated staff.

To increase the numbers of service users who are accessing the specialist needle exchange services at The BRIDGE Project and Project 6.

OBJECTIVES

To reduce the amount of shared injecting equipment by providing accessible free sterile injecting equipment (including a variety of syringe and needle sizes), materials to facilitate hygienic injecting practices, and sharps boxes.

To provide free disposal for used injecting equipment, and to encourage the safe disposal of contaminated waste.

To provide information on health issues, harm minimisation and local services using both literature and advice.

To contribute to the local information base about patterns of drug use and feedback on service provision.

To encourage service users to access local drug services and to make referrals where appropriate.

To provide, wherever possible, a needle exchange service between the hours of 0900 to 1800 Monday to Friday and between 0900 and 1230 on Saturdays. However, it is accepted that some pharmacies will take an afternoon closing once a week.

CONFIDENTIALITY Pharmacists and their staff should maintain the anonymity of service users. The pharmacist must ensure service user confidentiality is maintained. The Code of Ethics of the Royal Pharmaceutical Society provides guidance on confidentiality.

All information on service users recorded in the pharmacies is confidential to the needle exchange scheme and must not be divulged elsewhere. There may, however, be an occasion where confidentiality may have to be breached e.g. where are the police are involved due to an incident in the shop, child protection issues, public safety, threat of terrorism etc.

TRANSACTIONS, RECORD KEEPING AND ISSUE OF EQUIPMENT

All transactions must be undertaken by the pharmacist or designated members of the pharmacy staff.

The needle exchange database must be used for every transaction, unless in an emergency where there is no alternative but to use the paper record sheet.

There are no restrictions on the age of people who can access the needle exchange service at a pharmacy. Under-16s should be referred to a specialised unit dealing with young people as appropriate. New or inexperienced service users (regardless of age) should be strongly encouraged to access a specialist needle exchange (The BRIDGE Project or Project 6).

There are no actual limits on the numbers of needles and syringes that a service user can receive in one visit but it is recommended that no more than 40 should be issued at one time. Crack injectors may require more equipment than heroin injectors and it is our aim to issue one needle/syringe for each injecting episode. Pharmacy staff should display flexibility in dealing with service users and assess each transaction on its individual merits. It is also recommended that service users be issued with extra equipment in certain circumstances e.g. bank holidays, weekends etc.

If a service user does not return any used equipment, they should only be issued with 5 needles/syringes. If a service user is known to the pharmacist and brings in large number of returns or has been issued with a large yellow sharps bin, then this person may be exempted from the returns policy of the scheme.

All returned equipment should be returned in sharps boxes (but must not be refused if "loose") and must be placed in a large yellow sharps bin by the service user. Returns must not be handled by pharmacy staff under any circumstances.

The needle exchange scheme has a return rate target of 70% for participating pharmacies and it is important that pharmacies strive to reach this target in their own shop.

Injecting paraphernalia should always be issued to street drug users, whether it has been requested or not. It is generally recommended that filters/citric acid/swabs/spoons be issued in a ratio of 1 item to 1 needle/syringe. If filters are issued in bags of 10 then this should be the minimum amount issued as bags should not be opened and divided up.

Users of performance enhancing drugs do not require paraphernalia except possibly being issued with swabs.

The issue of black sharps is not currently recorded.

Normal standards of hygiene must be employed throughout the transaction.

RIGHT OF REFUSAL

Outlets retain the right to refuse to serve a service user if the pharmacist feels that there is a threat to staff or other customers. Pharmacies also have the right to ban service users for anti-social behaviour e.g. shoplifting, abuse. As with any other customer, the police may be called. A breach of confidentiality may be appropriate under these conditions.

ORDER AND DELIVERY OF EQUIPMENT

2 Pharmacies should keep adequate levels of stock and, where possible, order new equipment before they have run out.

Equipment is ordered by contacting the Needle Exchange Co-ordinator, who will aim to arrange delivery within 3 working days.

COLLECTION AND DISPOSAL

Requests for the collection of sharps bins are arranged by also contacting the Needle Exchange Co- ordinator, who will fax Cleansing the details in 2 working days.

Cleansing will give you a new supply of empty large yellow sharps bins.

Please note the Cleansing do not have designated collection days so please make sure that you order a collection in adequate time.

LEAFLETS AND ADVICE

Participating pharmacies will be issued with a number of relevant leaflets and expected to distribute them to service users. From time to time requests may be made to issue questionnaires and other evaluative items.

In line with their training, pharmacists should always endeavour to give advice to service users on access to drug agencies and other appropriate services.

PUBLICITY

The needle exchange scheme and its' outlets will be publicised through existing harm minimisation services and through partner agencies, as well as in scheme literature.

All pharmacies taking part in the scheme will be required to display the National Needle Exchange Scheme Logo in the door or window of their premises.

Publicity will also take place via word of mouth amongst service users.

FINANCE

All pharmacies are paid £400 per year for participating in the scheme, and receive an additional amount dependent on how many needles/syringes they issue in a quarter. These rates are as follows:

£60 for issuing 50-250 needles/syringes £75 '' 251-500 " £90 '' 501-1000 " £105 '' 1001-1500 " £125 '' 1501-2000 " £145 '' 2001-2500 " £170 '' 2501-3750 " £200 '' 3751-5000 " £260 '' 5001-7500 " £300 '' 7501-10000 " £400 '' 10000-12500 " £500 “ 12501-15000 “ £600 “ 15001-20000 “

The amount made payable is dependent on one member of the pharmacy staff having attended one training session each year. Pharmacies who have not sent one staff member of participation in a training session will only be paid £120 per year, plus the additional amounts outlined above.

3 TRAINING

Initial training will be made available to pharmacists and pharmacy staff on joining the needle exchange scheme.

At least one member of the pharmacy staff must have completed a training session organised by the scheme in order for the pharmacy to qualify for the initial payment of £400 per year (otherwise the payment will be £120 per year).

Regular specialised training sessions for pharmacy staff will be organised by the needle exchange scheme and held at The BRIDGE Project. Training will be provided by trainers from The BRIDGE Project and Project 6 - the local street drug agencies. The needle exchange scheme will pay the pharmacy £25 for each dispensing staff member to attend level 1 or 2 training sessions. Attendance at PED training sessions will result in a £15 payment per member of pharmacy staff.

All pharmacy staff and locums should be aware of the scheme's policies and guidelines and adhere to them.

It is important that all staff involved with service users have a positive attitude to the scheme. It is the responsibility of the pharmacist to ensure that any staff they employ are fully advised of the occupational health and safety procedures, especially with regard to the risk of infection.

There is a database training manual which covers all the issues on how to use the scheme database. The pharmacist should ensure that any members of staff who provide the needle exchange service are fully competent on database use. If you require any further database training then please contact the Needle Exchange Co-ordinator.

Other further training on scheme issues may be made available if required.

HEPATITIS B VACCINATION

The Department of Health recommends that the pharmacists and their staff participating in needle exchange schemes are vaccinated against Hepatitis B. The needle exchange strongly supports this recommendation. Any staff wishing to be vaccinated can contact either The BRIDGE Project or Project 6, where they can be vaccinated free of charge.

ADVICE AND SUPPORT

The Needle Exchange Co-ordinator can be contacted on (01274) 434206 between the hours of 0900- 1700 Monday–Friday. An answering machine facility is always available during ‘out of hours’ or when the co-ordinator is out or unavailable.

INSURANCE

Pharmacists participate at their own risk and should be covered by workplace insurance.

GENERAL PRECAUTIONS

Pharmacists should check the physical integrity of all sharps containers prior to handling.

All cuts and abrasions should be covered with a waterproof dressing.

NEEDLE STICK INJURIES

In the event of a needle stick injury the wound should be encouraged to bleed and then washed with hot water. The injury should be reported to the pharmacist immediately. The offending sharp should be kept for analysis. The affected person should report to the nearest Accident & Emergency

4 Department immediately. Current post-exposure prophylaxis guidelines should be followed. An entry should be made in the pharmacy accident book. An initial report should be made to the relevant insurance company is appropriate. Splashes of blood in the eyes or mouth should be irrigated with copious amounts of water, preferably running water.

SPILLAGE OF SHARPS

In the event of a spillage of sharps, the pharmacist must be alerted immediately. The public must be kept well away from the affected area. The used equipment should be cleared away as quickly and as safely as possible, and placed into a sharps bin. Protective gloves should be worn and the area cleaned with a suitable disinfectant agent.

COMPLAINTS

Any complaints about the needle exchange scheme or its representatives should be directed to the Environmental Health Manager (Specialist Services), 6th Floor, Jacob's Well, Bradford, BD1 5RW, telephone (01274) 434758.

5 I/We agree to comply with the specifications in this service level agreement.

Name of participating pharmacy:

Address:

Name of Pharmacist:

Signature:

Scheme Co-ordinator:

Signature:

Start of contract: 1st April 2007

Contract expires: 31st March 2008

This service level agreement will be reviewed annually.