National Enhanced Service s2

National Enhanced Service

Needle and Syringe Exchange Service

Template

This document forms the basis of a Service Level Agreement to be used in support of the Enhanced Service “EN2: Needle and Syringe Exchange” in the New Contractual Framework for community pharmacy.

How to use this template

This document is intended as the basis from which the LHB should produce its Service Level Agreement, and as such the elements within can be altered to suit local needs, as long as the minimum standards are adhered to. LHBs should give due regard to the National Health Service (Pharmaceutical Services) (Remuneration for Persons providing Pharmaceutical Services) (Amendment) (Wales) Regulations 2007 and the statutory obligations these regulations place on Local Health Boards to consult the relevant Community Pharmacy Wales Regional Committee on issues of remuneration for local Enhanced Services.

Any pharmacy entering into a contract with the LHB to provide this service must complete and submit form PS/ES/ CONTRACTOR LISTING.

Substance Misuse

This service supports the requirements of the ‘Substance Misuse Treatment Framework for Wales’ notes that:

‘ Needle and Syringe Exchange schemes exist within the wider context of harm reduction. These facilities aim to prevent the spread of blood-borne diseases (particularly HIV and hepatitis) and other drug related harm; including drug related death, as well as being important public health measures. Needle exchange facilities and harm reduction initiatives should provide easy access and a user-friendly, low threshold service for all injecting drug users that is equitable and culturally sensitive.

Overall, needle exchange facilities and harm reduction initiatives should be regarded as tier 2 specialist substance misuse services. However, facilities are also available in tier 1 services, most particularly in community pharmacies.’

This Service Level Agreement can be used to support the above requirements and should be used in conjunction with the framework, which can be found at; http://www.wales.gov.uk/subicsu/content/substance/sub-misuse-e.htm

Community Pharmacy Needle and Syringe Exchange Scheme

The primary aim of a community pharmacy needle and syringe exchange scheme is to help reduce the spread of HIV, Hepatitis C and other blood-borne diseases amongst injecting drug misusers by providing clients with convenient access to sterile injecting equipment and a facility for the safe disposal of used equipment. The Community Pharmacy Needle and Syringe Exchange Scheme should not be viewed in isolation but seen, as being an integral and complimentary part of the LHB’s strategy for substance misuse.

To be effective the scheme must operate on an exchange basis and participating pharmacies must make all efforts to encourage clients to return used equipment in exchange for new kits.

Scheme Eligibility

 Only those pharmacies located within and commissioned by the xxxxx Local Health Board (LHB) to provide a syringe and needle exchange service are eligible to provide the service. Although fees will be reviewed annually the contractual relationship will be of a permanent nature and will automatically roll over from year to year. Either party can terminate the agreement by giving the other party 90 days written notice.

 In the event of termination of the service the party terminating the service will ensure a minimum of 90 days notice of termination of the scheme is provided to patients receiving the service

 A pharmacy wishing to provide this service shall apply to the LHB.

 Participating pharmacies will display an “official” Needle Exchange logo in the front window or door of the pharmacy if required to do so.

1. Service description

1.1 Pharmacies will provide access to sterile needles & syringes, and sharps containers for return of used equipment. Where agreed locally, associated materials to promote safe injecting practice and reduce transmission of infections by substance misusers, will be provided.

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

1.3 Used equipment is normally returned by the service user for safe disposal.

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

1.5 The pharmacy will provide support and advice to the user, including referral to other health and social care professionals and specialist drug and alcohol treatment services where appropriate.

1.6 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. 2. Aims and intended service outcomes

2.1 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

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

2.3 To improve the health of local communities by reducing the spread of blood-borne infections and by ensuring the safe disposal of used injecting equipment.

2.4 To help service users access treatment by offering referral to specialist drug and alcohol treatment centres and health and social care professionals where appropriate.

2.5 To aim to maximise the access and retention of all injectors, especially the highly socially excluded.

2.6 To help service users access other health and social care support 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

3.1 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.

3.2 The pharmacy contractor has a duty 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.

3.3 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.

3.4 The pharmacy will allocate a safe place to store equipment and returns for safe onward disposal. The storage containers provided by the LHB commissioned clinical waste disposal service will be used to store returned used equipment.

3.5 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 are used to minimise those risks. A needle stick injury procedure should be in place.

3.6 The pharmacy should maintain appropriate records to ensure effective ongoing service delivery and audit. 3.7 Appropriate protective equipment, including gloves, overalls and materials to deal with spillages, should be readily available close to the storage site.

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

3.9 All pharmacists and staff involved in the delivery of this service should be offered immunisation for Hepatitis B.

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

3.11 The LHB should arrange regular contractor meetings to promote service development and update the knowledge of pharmacy staff.

3.12 The LHB will provide the exchange packs and associated materials and will 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.

3.13 The LHB will need to provide a framework for the recording of relevant service information for the purposes of audit and the claiming of payment.

3.14 The LHB will need to provide details of relevant referral points which pharmacy staff can use to signpost service users who require further assistance.

3.15 The LHB should consider obtaining or producing health promotion material relevant to the service users and making this available to pharmacies.

3.16 Additional scheme requirements

 The pharmacist entering into the commissioning arrangement will ensure that the equipment and facilities necessary for the provision of the service are available in the pharmacy.

 The pharmacy will carry adequate stocks of kits to meet the anticipated demand. Kits should be stored in such a way so as to be inaccessible to customers. The storage conditions must be appropriate for the storage of sterile medical equipment.

 With the exception of Bank Holidays the service will normally operate Monday to Saturday inclusive. Adjustments to the service will be made to cover those pharmacies not open on a Saturday.

 Safe handling arrangements are to be in place for dealing with the returned used equipment. It is important that sharp bins are assembled correctly as per the manufacturer instructions. The sharp bin should not be accessible to customers and if at all possible should not be stored in the dispensary.

 All transactions involving needle exchange must be conducted under the supervision of a pharmacist.  Pharmacists must ensure that clients place their used returned equipment in the sharp bin. Pharmacy staff must not handle used equipment.

 Unused kits returned by clients must be disposed of in the sharp bin; they must not be re-issued since their integrity cannot be ensured.

 All members of staff must exercise, and be contractually obliged to exercise, strict confidentiality in all matters relating to the Syringe and Needle Exchange service.

 All Pharmacists participating in the scheme must make arrangements to ensure that they have indemnity insurance that covers the provision of the service.

 The pharmacy will have in place a Standard Operating Procedure for the provision of this service and will review the SOP on an annual basis. Copies of the SOP will be provided to the LHB on request.

 Pharmacists will be required to adhere to all statutory requirements in relation to the storage and disposal of syringes and needles.

 The contractor must identify a named pharmacist who will take overall responsibility for ensuring the service is provided to the required standards.

 The contractor must ensure all pharmacists providing the service are appropriately registered with the Royal Pharmaceutical Society of Great Britain. The LHB may require evidence of this.

 The service should be conducted in accordance with any RPSGB guidance. This is currently contained in Medicines, Ethics and Practice at; www.rpsgb.org/pdfs/MEP29s3.pdf

4. Suggested Quality Indicators

4.1 The pharmacy has appropriate LHB provided health promotion material available for the user group and promotes its uptake. 4.2 The pharmacy reviews its standard operating procedures and the referral pathways for the service on an annual basis. 4.3 The pharmacy can demonstrate that pharmacists and staff involved in the provision of the service have undertaken CPD relevant to this service. 4.4 The pharmacy can demonstrate that the rate of return of used equipment meets locally agreed targets. 4.5 The pharmacy participates in an annual LHB organised audit of service provision. 4.6 The pharmacy co-operates with any locally agreed LHB-led assessment of service user experience.

5. Training and Education

5.1 Pharmacists providing this service will be expected to participate in appropriate Continuing Professional Development that complies with the criteria set by the RPSGB.

5.2 Pharmacists wishing to provide this service should have undertaken appropriate training through an agency such as the Welsh Centre for Postgraduate Pharmaceutical Education (WCPPE). WCPPE provides an appropriate distance learning course ‘Opiate treatment: Supporting pharmacists for improved patient care an open learning course for pharmacists (2002).’

5.3 The service will be provided in accordance with best practice and will comply with all relevant guidance contained in the latest edition of the RPSGB ‘Medicines, Ethics and Practice – A Guide for Pharmacists’.

5.4 The pharmacist entering into the agreement to provide the service will ensure that all staff involve in providing the service have been suitably trained and are aware of the need to respect patient confidentiality.

5.5 Locums and all support staff must be fully informed and suitably trained in relation to their involvement in the scheme.

6. Audit and Monitoring

6.1 Pharmacies are encouraged to self-audit this service.

6.2 The LHB reserves the right to undertake audit checks without prior notification.

7. Client Registration

7.1 Pharmacists must keep a record of each transaction if required to do so by the LHB. Clients registering for the scheme will be asked to provide details, as required by the LHB, and in return will receive a registration number. This number is to be used for subsequent exchanges at the pharmacy

8. Clinical Governance

8.1 Needle exchange services and harm reduction interventions are to take place within the context of NHS clinical governance arrangements in Wales.

9. Reimbursement

9.1 The fee payable for the provision of a community pharmacy needle and syringe exchange service is a combination of an annual retention fee and a fee for each kit issued.

(a) Annual Retention Fee £xxx

(b). Fee per kit issued £yyyy

9.2 The Annual Retention Fees will be paid annually at the commencement of the Financial Year.

9.3 The Fees for kits issued will be paid quarterly in arrears.

9.4 The above fees will be paid from: 1st April 20-- to 31st March 20—

9.5 Reimbursement rates for the service will be reviewed prior ro January each year and the revised rates will be effective from the 1st April. 9.6 The LHB will provide the pharmacy with forms to be used for the claiming of payment for the service and with details of the mechanism for remuneration.

9.7 Claims for payment will be subject to the LHB’s Post Payment Verification Process. Background information – not part of the service specification

The ‘Substance Misuse Treatment Framework for Wales’ sets out a series of aims and objectives for needle and syringe exchange services generally, these apply to services commissioned from community pharmacy and are reflected within the service specification:

 To offer user-friendly, non-judgemental, client centred and confidential services.  To assist clients in remaining 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 amongst injecting drug users.  To reduce drug-related deaths (immediate death through overdose and long-term e.g. through blood borne infections).  To promote safer injecting and safer sexual practices.  To provide focussed harm reduction advice and initiatives, including advice on overdose prevention (e.g. risks of poly-drug use and alcohol use).  To help clients access appropriate treatment by referral to other health/specialist agencies (e.g. treatment services, genitor-urinary medicine, social care and family support services).  To facilitate access to primary care where relevant.  To ensure the safe disposal of used injecting equipment.  To encourage the access and retention of all injectors, especially the highly socially excluded, through the low-threshold nature of service delivery and interventions provided.  To discourage initiation into injecting and to encourage alternatives to injecting.  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.  To reinforce the benefits of needle exchange and raise public awareness through information and education.

There is good evidence that community pharmacy based needle exchange services can complement and support other needle exchange and harm minimisation initiatives commissioned by drug treatment agencies.

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, www.nta.nhs.uk

National scheme logo:

WCPPE training which may support this service:

Distance Learning Package: Opiate treatment: Supporting pharmacists for improved patient care an open learning course for pharmacists (2002).