June 2010
Community Pharmacy Sexual Health Local Enhanced Service
Free EHC, Condoms, Chlamydia screening and treatment for under 25 year olds
You’re Welcome
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Welcome to the new sexual health local enhanced service specifications. This document contains all the relevant materials you will need in order to deliver the new service once it is launched in pharmacies starting 1 st June 2010. Each pharmacy will have its own sexual health toolkit that will contain the information contained herein, but with extra materials and resources.
Please make sure you read this entire document as it contains guidance on all aspects of the new service and is likely to answer any query you may have.
If this document doesn’t answer your questions, please refer to the following where appropriate:
ADMIN QUERIES Carole Roberts Public Health Directorate, Bristol PCT, South Plaza, Marlborough Street, Bristol BS1 3NX Tel 0117 900 2424 Fax: 0117 900 3409 e-mail: [email protected] Or Judy Campbell, Medicines Management Team Tel 0117 900 3423 email:[email protected]
CLINICAL QUERIES
Haider Al-Shamary
Medicine Management, Bristol PCT, South Plaza, Marlborough Street, Bristol BS1 3NX. Tel: 0117 900 2634 e-mail: [email protected]
Page Topic 4 You’re Welcome: A guide for services 7 Local Enhanced Service specification – including Expression Of Interest, fist claim form and EHC/Azithromycin claim form 15 Chlamydia screening 17 4YP Condom Card (C-Card) 22 Additional information; EHC PGD 30 Azithromycin PGD 43 C-Card Pickup and Monitoring Form 44 4YP Registration points 48 4YP GP Practices 52 Brook Outreach Team School drop ins 53 Child Protection Contact Numbers
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GOING LIVE
What Pharmacies need to do in order to start delivering the new service
1. Pharmacies should have signed up to the LES and claimed for the set up fees and returned the sign up and claim form to the Medicines Management team at the PCT; please read through the LES carefully and sign the relevant form at the end of the document.
2. Pharmacies should order condoms directly from Pasante and have them in stock as described at the training. Condoms can be ordered directly from Pasante using the order form provided in the pack provided at the training event (and also attached). Please note the minimum and maximum order requirements as highlighted on the form. Other resources, leaflets and posters are available from: 4YP at www.4ypbristol.co.uk : click “For Professionals” then “Resources”
3. Pharmacies should have discussed the c-card scheme and training with their counter staff before they commence the training.
• If you have any questions or concerns with regards to the C-card Scheme then please contact the C-card Co-ordinator: Kirsten Forseth, Bristol Public Health Directorate, 4 th Floor, South Plaza, Marlborough Street, Bristol BS1 3NX, e-mail [email protected] or telephone 0117 900 2562
4. Pharmacies should have contacted the Avon Chlamydia Screening office to order the chlamydia testing kits and publicity materials on 0117 376 3580 or by emailing [email protected] . Requests for further training can be made to Karl Pye, Coordinator on the above number or by emailing [email protected]
5. Supplies of azithromycin for the PGD will also be provided from the Avon Chlamydia Office, provided the pharmacy has a pharmacist who has attended the sexual health training and therefore, be able to offer this treatment from the Pharmacy.
6. EHC supplies under PGD will continue in the same way.
• Copies of the Patient Group Directions (EHC and Azithromycin) are available on the Community Pharmacy web pages: http://www.bristol.nhs.uk/Clinicians/pharmacy/patient%20group%20directions/ pgd.asp
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You’re Welcome
Quality criteria for making health services young people friendly
Starting out: A guide for services All young people are entitled to receive appropriate healthcare wherever they access it. The You’re Welcome quality criteria set out principles to support health service providers to improve their services and be more young people friendly. Why You’re Welcome is important to • Helps achieve and demonstrate progress for services: specific national requirements e.g. patient involvement. • You’re Welcome will be included in • Access to free resources e.g. templates, commissioning. It is a way for the PCT to training, etc. ensure that they commission high quality • health services that make young people, and Encourages young people to become better service users – accessing appropriately in a other service users, feel comfortable. timely manor, well informed and aware young • Provides evidence of quality to people and adults Commissioners. • Improves partnership working and resource • Provides an audit tool for service quality: allocation. You’re This gives a structured approach to Is our service appropriate for assessing the quality of a service. Welcome ? There is always room for improvement. • You’re Welcome is intended for services that You’re Welcome provides a tool for have a significant health component. assessing where improvements can be made. • Service eligible for You’re Welcome provide Encourages staff to identify what they direct access to an appropriately trained health are doing well and celebrate successes. care professional as a significant part of the service provided. • Helps deliver key elements of the Child • Health Programme 5-19. This includes NHS and independent, • primary, community, specialist and acute Increases efficiency, consistency and services, as well as services that are performance management. subcontracted to provide health services to • Provides leverage for change and young people. improvement. • • Getting You’re Welcome right for young It is appropriate for all health services; both people contributes positively to the experience young people specific and generic of all age users of your service.
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Once you think yourYou’re service has Welcome met the standard, you need to submit the toolkit to the • Postal, telephone and/or internet only health local You’re Welcome lead. services are excluded from applying for the You’re Welcome quality mark at this time. Quality criteria for making health services
young people friendly
You’re Welcome Must we work towards ? YW11 -19 • By 2020 there is an expectation that all 10 quality criteria: health services regularly used by young people – including all school and college 1. Access based services – will carry the You’re Welcome quality mark, a sign that they are 2. Publicity young people friendly. 3. Confidentiality and consent • PCTs have identified priority services which 4. Environment will need to start working towards You’re Welcome . 5. Staff training, skills, attitudes and • You’re Welcome values Overtime will be built into commissioning. 6. Joined-up working
7. Monitoring and evaluation, and
How do we become a You’re Welcome involvement of young people service? 8. Health issues for young people • The PCT has a You’re Welcome lead who will be able to offer you support and guidance. 9. Sexual and reproductive health If you are considering working towards services You’re Welcome , you should speak to your 10. Child and adolescent mental health local lead. services (CAMHS) – targeted and
specialist services for young people • Services need to complete the self on psychological wellbeing and assessment toolkit. mental health • The toolkit is divided into 10 quality criteria sections – all services must complete section Who should be involved? 1-8. Sections 9 and 10 are specific for certain Ideally, this should be a whole-staff settings. approach. It should not be one person’s For each of the criteria, you need to score responsibility to complete the toolkit (unless of your service. The toolkit provides guidance on course the service is only staffed by one what constitutes a You’re Welcome Standard. person). However, you should identify a named lead to coordinate the work. - Dividing the toolkit so different people • Approaches to completing the toolkit could take responsibility for completing specific include: sections.
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- Completing one section at a time in support and guidance on involving young staff meetings. people. - Establishing a small working group to be responsible for completing the toolkit What should we do next? (appropriate for larger services). • Speak to your local You’re Welcome lead (if you have not already done so). How long will it take to become accredited as You’re Welcome ? • Read through the toolkit to get a sense of the criteria. • This varies depending on the approach taken to completing the toolkit and the actions • Talk to other staff in your service and decide required to meet the standard. how you will approach completing the toolkit.
• There is no time limit for completing the Further information and the self assessment toolkit. toolkit is available from www.dh.gov.uk
Our service is delivered from several You’re Welcome different venues. Can we just complete one Implementation Lead toolkit? Name: Anne Colquhoun • No - The toolkit is for individual service Tel: 0117 9002635 settings. Email: [email protected] • It has a strong focus on location and it is therefore not appropriate to complete one toolkit for several branches of a service.
How will young people be involved? • Young people may be involved in verifying services as You’re Welcome . Your local lead will be able to provide you with more information about this. • For your service to meet You’re Welcome , you need to demonstrate that you have consulted and involved young people. Section 7 of the toolkit provides a place to evidence this. • When completing the toolkit, you should continually be trying to provide evidence of the difference your service makes to young people and how you know that this meets their needs. Good evidence could include how you have involved young people in the planning and coordinating of these services.
• and monitoring, how you have changed your service to meet these expressed needs and how you feedback to young people. • There should be a You’re Welcome Participation lead in your area who can offer January 2010, Due for next review: January 2012 (unless new recommendations are issued before this date. ) Page 666 of 555555
Community Pharmacy Local Enhanced Service for Sexual Health Services 2010/2011
Service Level Agreement
Contents: 1. Background information 2. Service description 3. Service outline 4. Aims and intended service outcomes 5. Pharmacy requirements 6. Clinical Incident Reporting 7. Monitoring and Audit 8. Administration and Payment 9. Signature Sheet Appendices: EHC PGD, azithromycin PGD, claim forms
1. Background Information The provision of sexual health services contributes to the following key local and national health priorities: • reducing the rate of teenage pregnancy by 50% • ensuring access to STI testing and treatment within 48 hours • achieving the Chlamydia screening target of 35% of all 15-24 year olds in 2010/11 All Community Pharmacies are required to provide some sexual health services as part of their essential services, e.g. promotion of healthy lifestyles, providing opportunistic sexual health advice in Public Health campaigns including supplying Chlamydia screening kits to young people under 25 years old, signposting people to other services (including Contraception and Sexual Health Services (CaSH), Genito-Urinary Medicine (GUM) and maternity access), and support for self-care.
The local enhanced sexual health services outlined in this document build on these essential services, and draw together the separate service elements already being commissioned in many Bristol pharmacies (e.g. EHC PGD), to provide a full and co-ordinated range of sexual health services.
This LES will operate from June 2010 until March 2013. It will be reviewed periodically in the light of any changes to pharmacy provision, success of the service and healthcare needs of the local population.
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2. Service description Community pharmacies offering the sexual health enhanced service will provide the following services to young people under 25
o To give advice on contraception, sexual health and sexually transmitted infections irrespective of the provision of treatment or condom supply o Emergency hormonal contraception via patient group direction (PGD) free of charge o Free Condom provision via the C-Card scheme o Free Chlamydia screening o Free Chlamydia treatment via patient group direction (PGD)
3. Service Outline
o Pharmacies will offer a patient centred and confidential service in line with the quality criteria of ‘You’re Welcome’ and Bristol’s local sexual health service for young people, 4YP, providing access to up to date information on sex, relationships and contraception to 13- 24 year olds o The pharmacy, as a provider of sexual health services to young people under the age of 25 years, will work towards achieving ‘You’re Welcome’ status by July 2011 o For more information about You’re Welcome visit http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/Publication sPolicyAndGuidance/DH_073586 for details) o Verbal advice (plus written advice supplied by PCT) will be provided on sexuality and reproductive system issues, including the avoidance of Sexually Transmitted Infections (STIs), advice on the use of condoms, the full range contraceptive methods including reversible, emergency and long-acting reversible contraceptive (LARC) methods o Condom provision via the C-card scheme, and signposting to other free condom options o Supply of emergency hormonal contraception to young women under 25 years via Patient Group Direction, and signposting when EHC is required but not covered by PGD. o Signposting to other services - NHS Bristol will provide up to date details of other local services which pharmacy staff can refer to when required e.g. counselling services, GUM clinic screening and management services for STI’s and HIV, psycho-sexual health within local networks. The information will include the location, hours of opening and services provided by each service provider. o Provide access to opportunistic Chlamydia screening and treatment of young men and women, with partner notification in accordance with the National Chlamydia Screening Programme.
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4 Aims and intended service outcomes
o To reduce health inequalities by improving access to a wider range of more integrated services from the most accessible member of the primary health care team, the pharmacist. o To raise awareness of the range of contraception options, and facilitate access to them. o To improve access to emergency contraception and sexual health advice and strengthen the local network of contraceptive and sexual health services and reduce the number of new cases of Sexually Transmitted Infections (STIs) and HIV by providing better sexual health promotion and improving access to GUM services. o To increase the use of EHC by women who have had unprotected sex and help contribute to a reduction in the number of unplanned pregnancies and abortions and increase knowledge, awareness and use of Contraceptive and Sexual Health (CaSH) services among clients seeking EHC following unprotected sex. o To improve the referral and signposting to other integrated sexual health services such as Psychosexual or erectile dysfunction services o To increase the uptake of condoms through the C-Card scheme o To increase uptake of the local Chlamydia Screening programme thus increasing the number of identified cases and increase the number of infected patients being treated. o To refer clients who may have been at risk of STIs to an appropriate service and encourage partner notification where possible through GUM services
5 Pharmacy requirements o Pharmacies wishing to provide these services must have an appropriate consultation room which provides a sufficient level of privacy (ideally at the level required for the provision of the Medicines Use Review service) and safety and meets agreed criteria (clearly designated, seating for patient and pharmacist and sound-proof so that conversations cannot be overheard).
o The pharmacy contractor has a duty to ensure that all pharmacists and staff involved in the provision of the service have relevant knowledge and are appropriately trained in the operation of the service, including confidential, sensitive patient centred communication skills.
o All pharmacists and staff involved in the provision of the service to the public must attend a PCT training session, organised by NHS Bristol. Pharmacies may start providing the service in lieu of attendance at training events, but accreditation must be achieved for the provision of Azithromycin on PGD. They must then attend refresher trainer at least once every 2 years. o The pharmacy contractor has a duty to ensure that all pharmacists and staff involved in the provision of the service are aware of and operate within appropriate pharmacy Standard Operating Procedures (SOPs) which must be in place
o The service will be provided in compliance with Fraser guidance, the Bichard Checklist and Department of Health guidance on confidential
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sexual health advice and treatment for young people aged under 16, in line with the sexual health policy for NHS Bristol
o All pharmacist staff involved in provision of this service must have attained level one Child Protection training every three years, either from a Child Protection trainer, or having completed the on-line CPPE package
o The pharmacy must maintain appropriate records to ensure effective ongoing service delivery and audit. Records will be confidential and should be stored securely and for a length of time in line with local NHS record retention policies.
o Pharmacists may need to share relevant information with other health care professionals and agencies, in line with locally determined confidentiality arrangements, including, where appropriate, the need for the permission of the client to share the information.
o NHS Bristol will provide a framework for the recording of relevant service information for the purposes of audit and the monthly claiming of payment.
o The pharmacy will offer the service for at least 5 days a week throughout their contracted core hours and, where possible, throughout their supplementary hours
o The pharmacy should clearly display any logos that are developed to brand any part or all of the service
6 Vetting and Barring Scheme
o The Vetting and Barring Scheme, which will replace current barring schemes is the most inclusive and largest system of its kind in the world and will become a legal requirement by November 2010. o Barring decisions will be taken by Independent Experts. o For the purpose of this scheme both paid employees and volunteers are subject to the same implications, restrictions and obligations – except in terms of the application fee (free for volunteers to register). o Once the scheme is fully implemented, it will mean that anyone who wants to work or volunteer with children or vulnerable adults in ‘Regulated Activity’ will be required to be registered with the ISA. o A barred person will be committing an offence should they seek employment or volunteering opportunity in regulated activity. o It will be an offence for any person to commence Regulated Activity without first being ISA-registered. o It will be an offence for an employer to hire a person in regulated activity without first confirming their ISA registration. o Employers, personnel suppliers and other statutory, business and public organisations have a legal duty to refer appropriate information to the ISA. o Anyone with a legitimate interest will be able to check a person’s registration status online.
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o Those with a legitimate interest and have registered this interest will be informed if an employee becomes de-registered from the scheme. o Eventually, it is anticipated that 11.3 million people will become ISA- registered over a five year period from 26 July 2010. o For more information please refer to http://www.isa- gov.org.uk/default.aspx?page=2 or call the VBS call centre on 0300 123 1111 o Bristol PCT will publish further guidance close closer to the time.
7 Clinical incident reporting To ensure that the information contained in the training and scheme agreements are sufficient we would encourage contractors to feedback to the PCT any adverse incidents that occur. This must be done by completing the Adverse Incident Report Form available from the Primary Care Trust website (http://www.bristol.nhs.uk/Policiesandguidelines/staff/non- clinical/incident_reporting/default.asp ). Please report incidents to the Medicines Management Team at NHS Bristol.
8 Monitoring and Audit o The pharmacy should review its standard operating procedures and the referral pathways for the service on an annual basis. o The pharmacy will demonstrate that pharmacists and staff involved in the provision of the service have undertaken CPD relevant to this service. o The pharmacy participates in regular PCO organised audit of service provision. o The pharmacy co-operates with any locally agreed PCO-led assessment of service user experience.
9 Administration and Payment The payment per patient will be paid monthly, within a month after receipt of activity data supplied on the specified form.
Unit for payment Payment Comments £ Retainer Per pharmacy £100 This is to cover any start- providing up , training and admin costs enhanced services not otherwise covered in per year full.
The retainer also covers C card condom provision and the administration of any associated paperwork.
Activity Per sexual health £5 Only Chlamydia tests related consultation received by lab for testing including will be paid for. This Chlamydia testing payment will be made automatically from lab information and pharmacies informed
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Per sexual health £10 Levonorgestel 1.5mg tablets consultation and azithromycin 4 x 250mg including provision capsules/tablets either of levonorgestel or reimbursed at drug tariff azithromycin via cost, or free stock provided PGD (whether suitable for treatment under PGD or not, provided paperwork and signposting completed)
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10 Pharmacy sign up
Local Enhanced Service Agreement 2010/11
Sexual Health Local Enhanced Service
I confirm that this Pharmacy wishes to sign up to the Sexual Health LES
Pharmacy Name and Address:
…………………………………………………………..
Pharmacy Signatory:
…………………………………………………………..
Signatory Name in capital letters:
……………………………………………………………
Position: ……………………………………………………………
Date: ……………………………………………………………
The NHS Bristol contact for this Agreement is Haider Al-Shamary, Locality Pharmaceutical Advisor (South).
Tel: 0117 900 2634 E-mail: [email protected]
Please note for contractual reasons we do require a signed hard copy of this page of the enhanced services agreement. Please sign and return to Haider Al- Shamary (details below):
Haider Al-Shamary NHS Bristol Marlborough Street South Plaza Bristol BS1 3NX
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SEXUAL HEALTH LES FIRST CLAIM Mail this notification with your first invoice Judy Campbell Medicine Management NHS Bristol 4th Floor South Plaza Marlborough Street Bristol BS1 3NX
From Pharmacy Name
Address
Please pay my start up and annual retainer cost for 2010/11 £100
Please pay by BACS to
Bank name
Bank address
Sort code
Account number
Any additional reference details you require
Additional comments / info I understand that details and claims may be investigated by the NHS Counter Fraud unit . Signed Date Print Name……………………………………………………….
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EHC & AZITHROMYCIN INVOICE
Mail this completed invoice to : Date: Judy Campbell Medicine Management NHS Bristol 4th Floor South Plaza Marlborough Street Bristol BS1 3NX
From: Pharmacy name and address Bank Details (first line and postcode) Bank name:
Sort Code:
Account number:
Time period this invoice covers*………………………………………………………..………………….
Number Value £
Total number of EHC interviews £10-00
Total number of supplies of Levonelle 1500 £6-00
Total number of supplies of Levonelle 1500 to nurses £6-00
Total Number of Azithromycin £10-00 consultations
Total invoice value
This form can be signed by a registered pharmacist, or registered pharmacy technician.
I submit this invoice for the work undertaken above and understand that confirmation of the amounts claimed may be sought or investigated by the NHS Counter Fraud unit.
Signe...... Date ......
Print Name ……………………………………………...... RPSGB No.
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YW11 -19 Offering chlamydia screening in Pharmacies
Eligibility 15 - 24 year olds Testing recommendation Test once a year or whenever you change your sexual partner
Transmission Passed on through sexual contact – vaginal, anal, oral sex and close genital contact
Symptoms Chlamydia is mostly asymptomatic and screening is targeted to this group who may not otherwise seek testing. During the process of offering chlamydia screening, if a person subsequently reports current (or resolved) symptoms, inform her/him that these may be due to other STIs as well as chlamydia and recommend s/he seeks a full STI screen as well as offering a screening test now– ask them to call their local Sexual Health clinic or contact the screening office
Information about the test Explain that chlamydia can be detected with a simple screening test and can be easily treated. The test requires giving some simple information and a urine sample or self taken vaginal swab. Contact details must be provided. Whilst no test is 100% accurate, the NAAT* test is highly sensitive and reliable for chlamydia. Results Results are usually available in about 2 weeks. The client is informed by the Chlamydia Screening Office by their preferred contact method - text, phone, letter, email How to promote?
Clearly display the kits in the pharmacy
Ask anyone within the age range whether they’d like to take away a free, confidential test
Offer test to anyone requesting EHC
Display posters and leaflets promoting chlamydia screening services
General Information
Chlamydia is the most common sexually transmitted infection in UK. Approximately 1 in 12 young people under 25 years old tested in the NCSP are positive. Often there are no symptoms Untreated infection can have serious long term health consequences. Women with chlamydia may develop pelvic inflammatory disease which may lead to
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Payments
Payment is made for any valid kit returned and processed by the screening office. All kits are coded to the particular venue (pharmacy) and details will be routinely passed to the PCT to organise payment
Ordering More kits and publicity materials can be provided by contacting the Screening office on 0117 376 3580 or by emailing [email protected] . Requests for further training can be made to Karl Pye, Coordinator on the above number or by emailing [email protected]
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Bristol Condom Scheme background
Aims To support young people (13-24 year olds) in making healthy sexual choices, by making it easier for them to access condoms when they need them and increasing opportunities for them to talk to trained workers.
Objectives • To make free condoms available from a number of easily accessible venues
• To ensure young people are getting up-to-date information about local Sexual Health and Contraception Services from local workers
• To increase numbers of young people receiving information about and instruction on use of condoms
The C-card scheme is one of many initiatives developed under the Bristol Teenage Pregnancy Strategy Action Plan to increase young people’s access to sexual health advice and services. In partnership with Bristol Youth and Play Service and a number of community led organisations, NHS Bristol Public Health Directorate is the lead agency for the scheme.
Who can receive condoms as part of the scheme? All young people aged 13 to 24 who have registered and been given a current and valid C-card.
How does it work? A young person goes to one of the C-card registration points across the city. They will have a confidential chat with a trained C-card worker, who will:
1. explain the scheme 2. check they are not under pressure to have sex 3. teach them the correct way to use condoms 4. discuss other issues, such as STI testing, emergency contraception and other contraceptive methods 5. answer any questions they might have.
They will then be given a card (C-Card) that can fit onto a key ring. They will be able to obtain free condoms from other agencies involved in the scheme (C-card pick-up points) by showing this card. Each C-card has an ID number and ten blank boxes on the back. One box is marked each time a young person receives condoms. When all boxes are filled they will need to go back for another chat with a C-card worker to re-register to get a new card. This gives them the chance to ask more questions or talk about any concerns they have.
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Why are we doing this? Sexually transmitted infections are a major public health concern in the UK. Chlamydia is the most common sexually transmitted infection, affecting one in ten sexually active young people.
In addition, there are many barriers to young people using condoms, such as cost, embarrassment and lack of availability. The C-card scheme addresses these barriers by making free condoms widely available in venues where young people meet. It also increases the opportunities for young people to talk to trained workers about relationships, sex and staying safe.
C-card scheme core values
Bristol young people want to know and trust the person who gives out cards or condoms. They want re-assurance that personal information will not be passed on, that parents and the wider community will not find out and that they will not be judged. They are most likely to ask for condoms if they are in places they usually go to and hence they do not need to travel to access them.
With this in mind, the core values of the C-card scheme are trust, confidentiality and ease of access. We want young people to know that:
• They can trust us to keep confidentiality • We will not judge them • It’s easy to get condoms if they have a C-card
As they carry out the scheme, all organisations and workers need to be constantly thinking of how they are getting these messages across to young people. For example:
• In publicising the scheme in their setting • Arranging ways for young people to access the scheme in that setting e.g.: drop in etc • Language, body language and approach used • Making confidentiality clear
More information about the C-card scheme and the 4YP badge can be found at: www.4ypbristol.co.uk . This includes a list of C-card registration points and other Pick-up points.
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C-Card Pick-up Point Training Programme for Counter staff
This training sheet is designed for dispensary staff and counter staff in community pharmacies who are preparing to offer a pick-up point for condoms, within the pharmacy, to young people. It will be delivered by the lead/senior pharmacist who will have familiarised him/herself with the content, including the background and core values of the Condom Scheme.
It will take approximately 30 minutes to complete.
A. Run through the Background and Core Values of the Bristol C-card Scheme. This will show how the pick-up point in the pharmacy fits into the scheme. Remind staff that you are a 4YP-badged pharmacy as you already provide free emergency hormonal contraception to under 20s.
B. Explain the Condom pick-up process:
PICK UP PROCESS
When a young person comes to the counter and asks for condoms and/or shows you their C-card:
• In order to respect the confidentiality of the young person - Do not make colleagues/clients aware that you are issuing condoms - Be aware of the volume of your voice
• Write the date (day/month) in the appropriate box on the back of the card
• Provide 6 condoms in a bag
• Complete the monitoring sheet by entering the date, card ID number, ticking to say that condoms were given and your initials
• If you fill in the last box on the card, remind the young person that they need to get a new card before they can collect more condoms
• Ask if everything is OK / would they like to see a pharmacist?
This is the basic pick up process. At times the young person will not present as described, having lost their card, not having a card, or all the boxes on the card may be dated.
The following scenarios give staff a chance to consider their response to some situations that they might meet.
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Please discuss or role play the following scenarios:
1. A young person asks you for condoms, but has forgotten/lost their C-card: - How will you respond to this in your pharmacy?
Issues to discuss: • Will the counter staff issue a couple of condoms? • If they do, they should explain that this isn’t the correct procedure and they must return with their card when they need more condoms. And refer them to a registration point* if necessary. • If you feel it is not appropriate for staff to give any condoms, they should help the young person to find an alternative source of condoms.
2. You notice that the same C-card had been used several times today, by different young people: - How will you respond to this in your pharmacy?
Issues to discuss: • The member of staff should make it clear that they have noticed that the card is being used by different young people. They should stress the importance of speaking to a worker when being issued with a card and that this is a simple process. Refer them to a registration point*. • Will the counter staff issue a couple of condoms? It will depend on the circumstances, but if they do, they should explain that they will not be given more condoms until they have their own C-card. • If you feel it is not appropriate for staff to give any condoms, they should help the young person to find an alternative source of condoms.
3. A young person says they haven’t yet joined the scheme but urgently need condoms: - How will you respond to this in your pharmacy?
Issues to discuss: • Will the counter staff issue a couple of condoms? • If they do, they should explain the importance of the registration process and refer them to a registration point*. • If you feel it is not appropriate for staff to give any condoms, they should help the young person to find an alternative source of condoms.
*A list of registration points and other pick-up points across Bristol is in your training pack, and is also available on the 4YP website www.4ypbristol.co.uk
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C. Managing the condom supply
Agree a named person who will take responsibility for the condoms and monitoring forms.
This person will oversee the making up of the bags of condoms that will be available behind the counter. They will keep the supply of condoms in a secure place away from sources of heat, damp or sunlight and order more as needed.
Ordering condoms: condoms can be ordered directly from Pasante using the order form provided in your pack. Please note the minimum and maximum order requirements.
Other resources, leaflets and posters are available from:
4YP at www.4ypbristol.co.uk : click “For Professionals” then “Resources”
NHS Knowledge, Resource and Information Service (KRIS) at http://www.avon.nhs.uk/kris/default.htm , tel: 0117 900 2568 (South Plaza) or 0117 323 5463 (Southmead).
4. Monitoring the scheme
The named person will make sure there is a monitoring form for the current month available with the bags of condoms and ensure completed forms are kept safely and returned quarterly by the pharmacist, with the EHC return form.
If you have any questions or concerns with regard to the C-card Scheme then please contact the C-card Co-ordinator: Kirsten Forseth, Bristol Public Health Directorate, 4 th Floor, South Plaza, Marlborough Street, Bristol BS1 3NX, e-mail [email protected] or telephone 0117 900 2562
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Additional Information for Pharmacists in Bristol Primary Care Trust using the EHC PGD
General policy on the supply of Levonelle 1500 emergency contraception by accredited community pharmacists under the terms of the accompanying Patient Group Direction
1. Objectives • To increase access to emergency contraception • To allow a faster response to clients needs, without the need to wait to see a doctor • To increase knowledge of emergency contraception and mainstream contraception in women under 25 years • To refer hard to reach patients, especially young people, into mainstream contraceptive services • To increase awareness of the connection between unprotected sex and sexually transmitted disease through advice and provision of a Chlamydia screening kit • To increase partnership working and improved communication between pharmacists and other Healthcare professionals • To enhance the pharmacists’ professional practice.
2. Supplier Emergency contraception may only be supplied by an accredited pharmacist. Medicine counter staff must be trained to refer each request for emergency contraception to the accredited pharmacist(s).
The pharmacist(s) must have completed the training detailed below. An accredited pharmacist will normally be available to supply emergency contraception during the opening hours of the pharmacy.
Supplies of Levonelle 1500 should be from your normal wholesaler. Reimbursement will be for the list price of the tablets. The product Levonelle One Step should not be used as the licensing and the patient information leaflets are different.
Supplies of Chlamydia screening kits should be obtained from the Chlamydia Screening unit, tel 0117 376 3580 or email [email protected]. It takes a couple of weeks for the kits to be assembled and sent out to pharmacies via a courier. You can request male test kits as well as female test kits.
3. Training • The pharmacist will have successfully completed the following: • Attendance at a CPPE course on emergency hormonal contraception or completion of the distance learning pack available on the CPPE website • The training course run by the PCT on ______.
• The pharmacist will then be accredited as an approved practitioner for providing this service. The pharmacist(s) will be responsible for the training of all
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pharmacy staff in their own pharmacy on referral of requests for emergency contraception. • The pharmacist will maintain clinical knowledge appropriate to their practice by attending relevant study days, courses and by making themselves aware of appropriate literature.
4. Premises The service can only be provided in an approved pharmacy, which should have a suitable area for consultation with the patient. This may be a quiet area within the shop where privacy can be maintained, rather than a separate room. The pharmacy will be required to provide dedicated window space for a window sticker and a poster giving information on emergency contraception and how to access it locally.
5. Indemnity • The pharmacist must ensure that their professional indemnity cover is either provided by the National Pharmaceutical Association (NPA) or other organisation, which has confirmed that this activity will be included in their policy.
6. Patient Confidentiality The public expects pharmacists and their staff to respect and protect confidentiality. This duty extends to any information relating to an individual which pharmacists or their staff acquires in the course of their professional activities. Confidential information includes personal details and medication, both prescribed and non- prescribed. Pharmacists and their staff are expected to operate their company confidentiality policies as well as being aware of the Medicines, Ethics and Practice guidance.
General Medical Council (GMC) statement about the duty of confidentiality:
‘Patients are entitled to expect that the information about themselves or others, which a doctor learns during the course of a medical consultation, investigation or treatment, will remain confidential. Any explicit request by a patient that information should not be disclosed to particular people, or indeed to any third party, must be respected save in the most exceptional circumstances, for example where the health, safety or welfare of the patient or someone other than the patient would otherwise be at serious risk.’
This duty of confidentiality applies equally to people who are under the age of 16.
The pharmacist should ensure that they make reference to the confidentiality they are able to offer the client and its limits in a statement at the beginning of the consultation. The pharmacist needs to ensure that any other pharmacy staff also observe these requirements for confidentiality.
For example: ‘‘I am able to supply emergency hormonal contraception free of charge in certain circumstances and in some circumstances I will be able to sell it to you”
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“I will need to ask you some questions so I can decide whether you are able to take the emergency hormonal contraceptive pills and understand the implications of doing so”
“Our conversation will be confidential, that means I will not tell anyone anything you tell me unless I think that you or someone else is at risk of suffering emotional or physical harm. In either of those cases I will need to talk to someone else but I will discuss this with you before I do so.”
“Whether I sell you with emergency contraception or supply it free of charge or if I am not able to give you emergency contraception on this occasion I will let you know where you can go to get further help with your contraception’’
7 Child Protection When seeing people under the age of 18 the pharmacist(s) is required to have regard to child protection/child in need issues. Any Pharmacist, who has any concerns about a young person seeking advice, can consult the duty community paediatrician. Ask to speak to the on-call community paediatrician for child protection via UHB switchboard 0117 923 0000 who offer a 24 hour service. The designated professionals at NHS Bristol/ Bristol Community Health who are based at South Plaza, Monday – Friday 9am-5pm can also be contacted for advice. Jackie Mathers, Designated Nurse for Safeguarding Children – Tel: 0117 900 2670 email: [email protected] Dr Jane Schulte, Designated Doctor for Safeguarding Children – Tel: 07823 533889 email: [email protected]
Alternative contacts for advice, support and all referrals are the Children and Young Peoples services based at: Ridingleaze House, Lawrence Weston (North)Tel: 0117 903 8700 Symes House, Hartcliffe (South) Tel: 0117 353 2200 Welsman, St Paul's (East/Central) Tel: 0117 903 6500 Disabled Children’s Team (covers all Bristol) Tel: 0117 903 8250 Children in Care Teams Tel: 0117 955 8231 Out of hours emergency duty team Tel: 01454 615465
If you have concerns that a child may be being neglected or abused - don't keep it to yourself, no one will criticise you for reporting genuine concerns.
You should make yourself aware of your company’s policy on Child Protection and/or access support materials such as the CPPE package Child Protection: A guide for the Pharmacy team.
7.1 Fraser Guidelines Competence The pharmacist should make and record a judgement about whether every client whom they believe to be under 16 is Fraser guidelines competent : • Whether the young person understands the potential risks and benefits of the treatment and the advice given. • That the value of parental support is discussed, the health professional encouraging the young person to inform parents/carers of the consultation and
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explore the reasons if the patient is unwilling to do so. They must also assure the young person that their confidentiality will be respected whether they inform their parents/carers or not. • Whether the young person is likely to have or continue to have sexual intercourse without contraception. • Whether the young person’s physical or mental health is likely to suffer if they do not receive contraceptive advice or treatment. • Whether it is in the young person’s best interests to provide contraceptive advice and treatment without parental consent.
Taking the above into consideration the pharmacist should decide if the young person is competent to receive advice and treatment. The consultation will be governed by the same terms of confidentiality whether or not the health professional considers the young person competent.
When a young person is judged not to be Fraser guidelines competent she should be referred to a CaSH service Doctor or GP.
7.2 Sexual Assault Referral Centre (SARC) ‘The Bridge’ offers a service of sexual assault support for men, women and children in the Avon and Somerset area. This service is based on the 2 nd floor at the Central Health Clinic, Tower Hill, Bristol. Young people can self refer or are referred to this service by healthcare professionals. Services available include crisis workers who offer free 24/7 telephone support, information and referral services to all survivors of sexual violence, their family and friends, as well as counselling and follow-up care. Contact telephone number: 0117 342 6999 Website: www.turntothebridge.org
7.3 Domestic Violence
Two phone lines that are available to offer advice in this situation are as follows: Bristol Domestic Abuse Forum: 0117 914 2232; and Childtime: 0117 929 1533.
8. Clinical support The accredited pharmacist should not be working in isolation and must feel confident to refer to other sources of information and support services such as, other participating pharmacists, and designated CaSH service staff, subject to the requirement for confidentiality. Attending update sessions enables you to see which pharmacies are involved and also meet clinical staff.
8.1 Medical referral The client should always be advised to talk to her GP or local CaSH service, regardless of whether a supply is made. However, where the pharmacist, on the basis of the information obtained, is not certain that Emergency contraception can be supplied; the client should be referred to a doctor immediately – available on the website www.4ypbristol.co.uk
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A referral letter has been designed for you to use for clients who are excluded from the PGD.
8.2 Copper IUCD Patients who choose or require referral for a copper IUCD as emergency contraception can be referred to the designated clinics on your clinic sheet. The pharmacist should advise the client that it is not always possible to fit an IUCD. If the woman wishes to have an IUCD but is also within the Patient Group Direction (PGD), Levonelle 1500 should be given and a referral made (by phone if possible) to an appropriate Young People’s clinic, CaSH service, Brook Advisory Service or GP. The woman should be advised to check that a doctor able to fit an IUCD for emergency contraception will be present in the clinic prior to her attending. Ring the Sexual Health information line on: 0117 342 6900. (Monday – Friday from 9a.m. to 5p.m.)
9. Client groups The main group is young women under the age of 25, who for whatever reason might require emergency contraception. Most will self refer or may be sent by other healthcare professionals including pharmacists not participating in the scheme. Only in exceptional circumstances women aged 25 and over can be supplied Levonelle 1500 via the PGD if they are unable to access a supply from another NHS source before the 72 hour limit, assuming that they fulfil all other criteria in the PGD.
10 Intended outcome • The client is able to make an informed choice about whether to use Levonelle 1500 or another method of emergency contraception. • The client is safely supplied with Levonelle 1500 with information about correct usage and when to seek help with any problems. • The client is made aware of the need to consider a more reliable method of contraception or help with her current choice. • The client is made aware of the support and follow up available to them through local Young People’s Clinic, CaSH service, Brook Advisory Service, GUM and their GP. • To increase awareness of the connection between unprotected sex and sexually transmitted disease and to increase Chlamydia screening uptake
NB: the risks of undergoing an unintended pregnancy and/or termination generally outweigh those of using hormonal emergency contraception.
11. Managing the Consultation in the Pharmacy All requests for emergency contraception must be dealt with sensitively and discreetly. Medicine counter staff must refer all such queries to the pharmacist without delay.
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The pharmacist must personally speak with and counsel the person requesting emergency contraception. Advice may be given over the telephone but emergency contraception can only be supplied, in person, to the intended user. Friends, relatives and other third parties may not collect a supply on behalf of the intended user. If a person requests a supply on behalf of another, the pharmacist must ensure that they are given appropriate advice and information to pass on to the intended user.
11.1 Supply of Levonelle 1500 During the consultation, the pharmacist must obtain the information outlined in the pro-forma before making any recommendation regarding emergency contraception.
A single pack of the emergency contraceptive pill can be supplied if • The pharmacist is satisfied that emergency contraception is appropriate • The pharmacist is satisfied that the client understands the circumstances in which emergency contraception will be effective.
The product may only be supplied for use at the time and should not be supplied for possible future use.
11.2 Verbal advice A verbal warning should be given that the tablets may rarely be associated with nausea of vomiting. If vomiting or severe diarrhoea occurs within 3 hours of taking the tablet they need to seek further advice from a pharmacist, GP or CaSH service.
In addition the pharmacist should: - Emphasise the failure rate and the need for follow up. - Stress that this supply takes care of this episode of unprotected sex only - Advise the practice of abstinence or careful use of barrier method until the onset of the next period and discuss future contraceptive need - Discuss where appropriate the association of unprotected sexual intercourse with the risk of Sexually Transmitted Infections and offer a Chlamydia screening kit for the client to take away.
11.3 Written advice Clients supplied with Levonelle 1500 should be given the following before they leave the pharmacy • Dose, information and advice sheet on Levonelle 1500 • Guidance on how to take, what happens next, what to do if tablets lost / vomited
All clients receive Information pack – this pack contains two condoms, a Contax 4U booklet, information on EHC, and information on how to put a condom on.
11.4 Follow up All clients should be advised to make a follow up appointment with the Young People’s Clinic, CaSH service, Brook Advisory Service or GP for ongoing
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Clients supplied with Levonelle 1500 should be advised to attend Young People’s clinic, CaSH service, Brook Advisory Service or GP 3-4 weeks after supply to ensure that the method has worked.
Follow up is essential if: • They do not have a period within 3-4 weeks of taking the emergency pill • Or the period is unusually light, short, or painful (failed method / ectopic pregnancy) In either case they should take an early morning sample of urine with them to their follow up appointment.
12. Record keeping and payment Pharmacists must keep a record of the consultation and its outcome on the Record Sheet for supply of Levonelle 1500 that has been provided. Ideally computerised medication records should also be kept.
Client records must be kept by the accredited pharmacy for 8 years if the client is believed to be over 16 and until the client’s 26 th birthday if they are believed to be under 16 .
Client information should be transferred from the pharmacist’s record sheet (yellow form) to the Quarterly Client Data information sheet and this sheet submitted to Anne Colquhoun, Bristol Teenage Pregnancy Strategy Co-ordinator who is monitoring the EHC scheme.
The consultation fee is £10.00 regardless of whether or not a supply of Levonelle 1500 is made. The cost of Levonelle 1500 supplied will also be reimbursed
13. Adverse drug reactions (ADRs) Levonelle 1500 is the only method of emergency contraception to be supplied under this PGD by accredited pharmacists in accordance with the Summary of Product Characteristics unless otherwise stated .
Whilst rare, all serious ADRs must be reported, even if the effect is well recognised. See British National Formulary (BNF) for supporting information. ADRs should be reported to the Committee on the Safety of Medicines, using the yellow ADR card system. The cards are available in the BNF.
A client presenting with a suspected ADR should be referred to a doctor for further investigation.
14. References • See PGD for full list • Medicines, Ethics and Practice A Guide for Pharmacists (current version)
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Any change to evidence based knowledge about this product will be communicated to practitioners and any new published guidelines from the MHRA (Medicines and Healthcare Regulatory agency) or FSRH will be acted upon.
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Azithromycin Patient Group Direction
Staff Characteristics • Pharmacist registered with the RPSGB who has undertaken relevant training as specified by NHS Bristol • Has undertaken appropriate training to carry out clinical assessment of patient who requires treatment according to the indications listed in the PGD • Has undertaken appropriate training for working under patient group directions for the supply and administration of medicines • Has undertaken training appropriate to this PGD in line with current requirements of the BNSSG Contraception & Sexual Health Services Guidelines Group [reference 1] THE PHARMACIST MUST BE AUTHORISED BY NAME, UNDER THE CURRENT VERSION OF THIS PGD BEFORE WORK ING ACCORDING TO IT [references 2-6]
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Clinical Details Indication Male and female clients 12-24 who have a positive genital Chlamydia result following screening by the Avon Chlamydia screening programme.
Sexual contact of a client with positive genital Chlamydia result
Inclusion criteria Age – adults and young people over the age of 12 years up to and including those aged 24 years
Weight 45kg or more
Young persons under the age of 16 years should be competent under the Lord Fraser guidelines (or have treatment consent from a carer with parental responsibility) [reference 9]
In a female client the risk of pregnancy is nil or negligible 1.
Clinical Details • No valid consent Exclusion criteria • Age less than 12 years • Age 25 years or above • Weight less than 45kgs • Known hypersensitivity to azithromycin or other macrolide antibiotics (erythromycin, clarithromycin or spiramycin) or serious adverse reactions with previous treatment with azithromycin • Hepatic disease • Renal impairment • Acute Porphyria • Pregnancy or breast-feeding. • History of cardiac disease
1 Recent publications form the FFPRHC CEU refer to being “Reasonably certain the woman is not pregnant” and define this as “has not had intercourse since the last normal menses; has been correctly and consistently using a reliable method of contraception; is within 7 days after normal menses; is within 4 weeks postpartum; is within 7 days post-abortion or miscarriage; is fully or nearly fully breastfeeding, amenorrhoeic and <6 months postpartum. Pregnancy testing adds weight to the diagnosis”. [reference 10] The authors of this PGD add that the interval from the last unprotected intercourse to the pregnancy test should be at least 3 weeks.
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• Predisposition to QT interval prolongation (including electrolyte disturbances) • Male client with scrotal pain • Female client with pelvic pain • Presence of genital tract symptoms: *Urinary symptoms such as stinging when passing urine *Penile discharge *Unusual vaginal discharge and/or bleeding *Concomitant conjunctivitis and/or joint bleeding • Concurrent use of any of the following drugs is an exclusion: Terfenadine Ciclosporin (cyclosporine) The anticoagulants ; warfarin, acenocoumarol (nicoumalone) or phenindione. Digoxin Theophylline Nelfinavir Cisapride Rifabutin Reboxetine Mizolastine Antimalarials Quetiapine Sertindole Ritonavir Methysergide Ergot derivatives ; ergotamine or proprietary products containing ergotamine “Cafergot”, “Migril”. These are all drugs for migraine.
Concomitant use of drugs that prolong the QT interval such as; amiodarone, cisapride, amitryptyline or sumatriptan .
Check appendix 1 of the latest version of the BNF www.bnf.org for a comprehensive list of potential drug interactions and go to www.medicines.org.uk (search under ‘azithromycin’ and view summary of product characteristics (SPC)) for further information.
Management of Record the reason for exclusion / referral in the case records. excluded patients Record any advice given. Refer to a doctor or CaSH service such as Bristol Sexual Health Centre, and highlight the need to seek further medical advice. Action for patients not Record the refusal in the case records. wishing to receive care Refer to a doctor where appropriate. under this PGD Record any advice given in patient’s notes.
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Drug Details Name, form & strength Azithromycin capsules 250mg of medicine (Tablets may be used if capsules are not available) Legal classification POM
Route/Method Oral
Dosage 1g stat dose to be given as a supervised dose Maximum dose : as above
Frequency As required
Duration of treatment Single stat dose
Maximum or minimum Single stat dose treatment period Quantity to 4 x 250mg capsules supply/administer (Tablets may be used if capsules are not available) Cautions Drug interactions See exclusion section and current edition of the BNF for full details of interactions.
Concurrent use of the following require special advice for the patient • Combined oral contraceptive (COC) pill. – see “Advice to patient” section • Antacids – see “Advice to patient” section
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Drug Details Side effects Azithromycin is well tolerated with a low incidence of side effects. The most common side effect is nausea. Other occasional side effects include loss of appetite, vomiting and diarrhoea. These usually settle by themselves and the patient should be reassured. Rarely anaphylaxis can occur.
For a comprehensive list of possible side effects please see the latest BNF, or go to www.medicines.org.uk (search under ‘azithromycin’). Advise to contact the clinic if the patient experiences any adverse effects to the treatment. Any side effects should be recorded in the notes and the client referred to a doctor where necessary.
Use the Yellow Card System to report adverse drug reactions directly to the Committee of Safety in Medicines (CSM). Yellow Cards and guidance on their use are available at the back of the BNF as well as on the MHRA website (www.yellowcard.gov.uk). Advice to patient The Pharmacist should check that the client understands the reason for treatment and how the treatment should be taken.
Swallow capsules whole on an empty stomach; advise no food for 1 hour after taking capsules.
Warn of side effects such as gastro-intestinal upset and skin rash
The manufacturer’s patient information leaflet should be given. Offer verbal and written information on Chlamydia infection and its treatment.
The importance of sexual partner(s) being evaluated and treated should be highlighted. The client should be advised to abstain from any sexual intercourse (including protected vaginal, anal and oral sex) whilst taking treatment and until partner(s) have completed treatment and waited 7 days following treatment with Azithromycin. Antacids The client should be advised to take the medication at least one hour before or two hours after food or antacids.
Combined oral contraceptive pills (or patches) Women on the combined pill should be advised according to the latest guidelines from the Faculty of Family Planning 2
2 The FFPRHC CEU guidance Drug interactions with hormonal contraception April 2005 [reference 12] says that: “a COC user taking a short course ( less than 3 weeks) of non-liver enzyme- inducing antibiotics should be advised to use additional contraceptive protection, such as condoms, during the treatment and for 7 days after the antibiotic has been stopped. If fewer than seven active pills are left in the pack after antibiotics have stopped, she should omit the pill-free interval (or discard any inactive pills).”
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The client should be advised to avoid sexual intercourse during treatment and for the 7 days following treatment. If abstinence from sexual intercourse can not be achieved, the patient should be strongly advised to use protection (condom) during the treatment and for 7 days after the antibiotic has been stopped. If fewer than 7 active pills are left in the pack after the antibiotic has been stopped, she should omit the pill-free interval (or discard any inactive pills). Similar advice applies to contraceptive patch users.
Equivalent advice applies to contraceptive patch users but “the efficacy of progestogen-only methods of contraception is not reduced by non-liver enzyme-inducing antibiotics and additional contraceptive protection is not required”
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Records and Follow Up Referral arrangements As per local arrangements / protocol and Avon Chlamydia Screening Programme Protocol
Records/audit trail Record the consultation in line with the NMC Guidelines for records and record-keeping [reference 13] and the service protocol. Patient’s name, address, date of birth and consent given
Ensure that the documentation meets the service’s requirements for audit trail. This should include the date of administration as well as the signature of the person supplying the azithromycin. Also record the batch number, expiry date and quantity of azithromycin supplied (see below).
Diagnosis and suitability for treatment under PGD confirmed with Avon Chlamydia Screening Programme where not ascertained in full by staff operating under the PGD
Azithromycin PGD followed Diagnosis Name of medicine Dose and form administered Date and time given Amount given Batch number if appropriate Expiry date Signature and name of health professional administering medicine Advice or warnings given to patient Details of any exclusion or refusal Referral arrangements (including self care) Details of any adverse drug reactions and actions taken
Follow up As per local arrangements / protocol
Incident Reporting Incidents need to be reported in accordance with NHS Bristol’s incident reporting policy.
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Reference to National/Local policy and guidelines
1. BNSSG Contraception & Sexual Health Services Guidelines Group 2005; Training and experience requirements for BNSSG Contraception & Sexual Health Services nurses prior to use of PGDs October 2005 2. Department of Health (DH), Review of Prescribing, Supply and Administration of Medicines. Final Report 1999 www.dh.gov.uk 3. Department of Health (DH), Patient Group Directions (England only) (HSC) 2000/026 www.dh.gov.uk 4. Royal College of Nursing Patient Group Directions Guidance and information for nurses (publication code 001370) 5. NMC Code of Professional Conduct (2002) www.nmc.org.uk 6. NMC Guidelines for the Administration of Medicines (2002) www.nmc.org.uk 7. Clinical Effectiveness Group (Association for Genitourinary Medicine and the Medical Society for the Study of Venereal Diseases) National Guideline on the Management of Non-gonococcal Urethritis 2002 www.bashh.org 8. Clinical Effectiveness Group (Association for Genitourinary Medicine and the Medical Society for the Study of Venereal Diseases) National Guideline on the Management of Chlamydia trachomatis Genital Tract Infection 2002 www.bashh.org 9. Department of Health 2004, Best practice guidance for doctors and other health professionals on the provision of advice and treatment to young people under 16 on contraception, sexual and reproductive health . Gateway reference number 3382 29 July 2004 10. Faculty of Family Planning & Reproductive Healthcare 2005 Clinical Effectiveness Unit Guidance; The use of contraception outside the terms of the product licence July 2005 www.ffprhc.org.uk 11. British National Formulary (BNF 58 September 2009) and Electronic Medicines Compendium accessed at www.emc.medicines.org.uk on 05/01/2010 12. Faculty of Family Planning & Reproductive Healthcare 2005 Clinical Effectiveness Unit Guidance; Drug interactions with hormonal contraception April 2005 www.ffprhc.org.uk 13. NMC Guidelines for records and record keeping (2002) www.nmc.org.uk 14. Family Planning Association Leaflet on Chlamydia http://www.fpa.org.uk/Information/Readourinformationbooklets/chlamydia
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This patient group direction must be agreed to and signed by all health care professionals involved in its use. The PGD must be easily accessible in the clinical setting Organisation NHS Bristol South Plaza Marlborough Street, Bristol, BS1 3NX
Authorisation PCT Head of Name: Sue Mulvenna Medicines Signature: Date: Management
PCT Clinical Name: Dr Tony Fielding Governance Lead Signature : Date:
Name: Signature: Date: Name: Signature: Date:
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Individual Authorisation
I have read and understood the Patient Group Direction and agree to supply this medicine only in accordance with this PGD. PGDs DO NOT REMOVE INHERENT PROFESSIONAL OBLIGATIONS OR ACCOUNTABILITY. It is the responsibility of each professional to practice only within the bounds of their own competence and in accordance with their own code of professional conduct. Note to Authorising Managers : Authorised staff should be provided with an individual copy of the clinical content of the PGD and a photocopy of the authorisation sheet showing their authorisation.
Name of Signature Authorising Date Pharmacist Manager
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Azithromycin supply Pharmacist Record Sheet
(This record should be kept for a minimum of 8 years if the client is believed to be over 16 and if they are believed to be under 16 the record should be kept until their 26 th birthday)
Age___ and Date of Birth: ______Post code:
CSP Number: ______
Time: ______Day: ______Today’s Date: ______
Where did you hear about this service? : ______
Pharmacy: ______
Pharmacist’s Name and registration number: ______
Client’s Name (Not essential): ______
Current medication (inc herbal): ______
Known allergies: ______
Any C/I to Azithromycin: ______
Current or past serious illness______
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Fraser Guidelines This applies to clients who are believed to be less than 16 years of age. Discussion with the young person should explore the following issues at each consultation. This should be fully documented and should include an assessment of the young persons maturity. Fraser Guidelines Assessment Yes No Understands the advice given Encouraged to involve parents Adverse effect on the physical or mental health of the young person if advice or treatment withheld Action is in the best interests of the young person Is likely to continue with sexual activity without advice or treatment
Counselling given Yes No Reason, administration information and side effects discussed Azithromycin taken on premises Importance of sexual partner(s) being evaluated/treated Interaction information if appropriate Advise to attend GP/ CaSH if adverse effects or other worries Patient Information Leaflet and medication provided
Other relevant notes:
Action taken
Inclusion: Batch number / expiry date of Azithromycin capsules provided: ______
Patient Information Leaflet given (from Azithromycin pack) Yes No
Dose supervised: Yes No
Exclusion Reason______Referral Reason______
Non Supply Reason______
The above information is correct to the best of my The action specified was based upon the information knowledge. I have been counselled on the use of given to me by the client, which, to the best of my Azithromycin and understand the advice given to me knowledge, is correct. by the nurse/pharmacist.
Client Pharmacist Signature: Signature: Date: Date:
Time taken to complete consultation ______minutes
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CC--ccaarrdd ppiicckk--uupp ppooiinntt MMoonniittoorriinngg FFoorrmm
Return quarterly to Ami-Louise Duggan, NHS Bristol PCT, 4 th Floor, South Plaza, Bristol, BS1 3NX or email [email protected]
C-card monitoring for the month(s) of:
Name of Pharmacy:
Fill in for users picking up condoms
Date Card ID number Condoms Worker’s given initials
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C-CARD REGISTRATION POINTS
NORTH BRISTOL
AVONMOUTH
Avonmouth Youth Centre Open for C-card: Tuesday evenings 6.30 – 9pm and Friday evenings 7 – 9.30pm
Avonmouth Medical Centre Collins Street, Avonmouth, BS11 9JJ Tel: 0117 982 4322 Open for C-card: 8.30am – 5.30pm Monday to Thursday, closed 5 pm Friday
LAWRENCE WESTON
Juicy Blitz 70 Ridingleaze, Lawrence Weston, BS11 0QB Tel: 0117 982 4963 Open for C-card: Tuesdays, Wednesdays and Thursdays 4 – 7:30pm
Lawrence Weston Youth Project Long Cross, Lawrence Weston, BS11 0RX Tel: 0117 907 7767 Open for C-card: Wednesday evenings 6.30 – 9pm and Sunday evenings 7 – 9.30pm
HENBURY
Bradgate Surgery 1 Ardenton Walk, Brentry, BS10 6SP Tel: 0117 959 1920 Open for C-card: 8:15am – 6:30pm Monday to Friday
Brentry & Henbury Youth Project Brentry Lodge Youth Centre, Machin Road, BS10 7HQ Open for C-card: Wednesday afternoons 3:30 – 6pm
SHIREHAMPTON
Avon Youth Association Youth Bus Ridge Road Open for C-card: Thursday 7 – 9.30pm
Shirehampton Health Centre Pembroke Road, Shirehampton, BS11 9SB Tel: 0117 916 2200 Open for C-card: Monday-Friday 8:30am – 6:30pm
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WESTBURY
AYA Youth Bus Canford Cemetery, Westbury-on-Trym Open for C-Card: Wednesday 7 – 9.30pm
CENTRAL & EAST BRISTOL
CITY CENTRE
Bristol Sexual Health Centre Central Health Clinic Tower Hill, Bristol BS2 0JD Tel: 0117 342 6900 C-card registration and pick-up available: Monday, Tuesday and Thursday: 9am – 6.30pm; Wednesday 10am – 6.30pm; Friday 9am – 4.30pm and Saturday 9.30am – 12 noon
Connexions 4 Colston Avenue, Bristol, BS1 4ST Tel: 0117 9873700 C-card available: Monday, Tuesday & Thursday 9:30am – 4:30pm Wednesday 10:00am-4:30pm Friday 9.30am – 4:00pm
Off the Record 2 Horfield Road, St Michael’s Hill, BS2 8EA Tel: 0117 922 6747 C-card registration available on Tuesday afternoons (1 – 5pm). Please call first and book. C-card pick-up available Monday, Tuesday & Wednesday (11:30am – 5pm) Note: Closed on Wednesdays during August 2008
1625 Independent People (formerly Wayahead Housing Support) Kingsley Hall, 58-59 Old Market Street, BS2 OER Tel: 0117 317 8800 C-card available: Monday, Tuesday, Thursday, Friday 10am – 5pm Wednesday 2pm – 5pm
BARTON HILL
Barton Hill Youth Project 202 Avonvale Road, Barton Hill, BS5 9SX Tele: 0117 304 1443 C-card available on Tuesday evenings (4 – 6pm)
Wellspring Healthy Living Centre Beam Street, Redfield, BS5 9QY C-card registration available at young people’s drop-in clinic on Mondays (4 – 6pm) and from 4:30 – 5pm on Tuesday, Wednesday, Thursday and Friday, C-card pick up available at reception Monday to Friday 8am – 6pm
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EASTON
Baggator Social Club The Pickle Factory, 13 All Hallows Road, Easton, Bristol BS5 0HH Tel: 0117 955 7733 C-Card (registration and pick up): Monday 5 – 7pm; Tuesday 7 – 9pm (Health drop-in clinic); Wednesday 5.30 – 9pm
The Mill Youth Centre Lower Ashley Road, Easton, BS5 0YJ Tel: 0117 951 0188 C-card available on Wednesday afternoons (1 – 4pm) and Thursday evenings (5:30 – 9pm)
Seymour Medical Practice Charlotte Keel Health Centre Seymour Road, Easton, Bristol BS5 0UA Tel: 0117 902 7155 C-card: 8.30a.m. – 12.30p.m. and 1.30p.m. – 6.30p.m. Monday to Friday.
FISHPONDS & SPEEDWELL
AYA Youth Bus At the entrance to Bookers Cash and Carry, Whitefield Road, Speedwell Open for C-card: Tuesday 7 – 9pm
Hillfields Youth Centre Thicket Avenue, Fishponds, BS16 4EH Telephone: 0117 903 8346 C-card available on Tuesday evenings (7 – 9:30pm)
ST PAULS
Docklands Youth Centre (St Pauls) New St Paul’s Settlement, Brigstocke Road, St Paul’s, Bristol BS2 8UA Telephone: 0117 942 0516 C-card available on Tuesday and Thursday evenings (6.30 – 9.30pm)
SOUTH BRISTOL
BEDMINSTER
Malago Surgery 40 St John’s Road, Bedminster, Bristol, BS3 4JE Tel: 0117 966 3587 Open for c-card: 8.30am – 12.30pm and 2 – 6.30pm Monday to Friday
BRISLINGTON & ST ANNES
Brislington Community Partnership – Skateboard Project Find them at Wicklea Youth Centre
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281 Wick Road, St. Anne’s, Bristol, BS4 4HR C-card available: Saturdays 1 – 4pm
Wicklea Youth Centre 281 Wick Road, St. Anne’s, Bristol, BS4 4HR Tel: 0117 983 7797 Open for C-card: Monday & Tuesday evenings 7 – 9.30pm
HARTCLIFFE & WITHYWOOD
Hareclive Youth Centre Hartcliffe Youth Project ‘The Core’, Moxham Drive, Hartcliffe, Bristol, BS13 0HP Open for C-card: Mon- Fri 7 – 10pm
Hartcliffe Club for Young People Gatehouse Avenue, Withywood, Bristol, BS13 9AE Open for C-card: Tues and Thurs 7 – 10pm
KNOWLE
Eagle House Youth Centre Newquay Road, Knowle West, BS4 1EG Tel: 0117 9777795 or 0117 3772644 Open for C-card: Mon-Thur 7 – 9:30pm C-card also available on Mondays and Tuesdays 10am-2pm but call first to make an appointment.
Knowle West Media Centre Leinster Avenue, Knowle West, BS4 1NL Tel: 0117 903 0444 ext.220 Open for C-card: Monday – Friday from 9am – 6pm
The Park The Park, Daventry Road, Knowle West, BS4 1QD Tel: 0117 903 9796 Open for C-card: Mon- Fri 9am – 4:30pm
STOCKWOOD
AYA Youth Bus (until the end of August 2009) Top end of Sturminster Road (by the open green field) Open for C-card: Saturday 7pm – 9pm
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GP Practices
AVONMOUTH Avonmouth Medical Centre Collins Street, Avonmouth, BS11 9JJ Open 8.30 am – 5.30 pm Monday to Thursday, closed 5 pm Friday Phone 0117 982 4322 for an appointment OR just drop in and ask for a 4YP appointment
BEDMINSTER Lennard Surgery 1 Lewis Road, Bedminster Down, Bristol, BS13 7JD Open 8.30 am – 6.30 pm Monday to Friday Phone 0117 964 2211 for an appointment OR just drop in and ask for a 4YP appointment
Malago Surgery 40 St John's Road, Bedminster, Bristol, BS3 4JE Open 8.30 am – 12.30 pm and 2.00 - 6.30 pm Monday to Friday Phone 0117 966 3587 for an appointment OR just drop in and ask for a 4YP appointment
BRISLINGTON Brooklea Health Centre Wick Road, Brislington, BS4 4HU Open 8.30 am – 12.30 pm and 2.00pm - 6.00pm Monday to Friday Phone 0117 330 4300 for an appointment OR just drop in and ask for a 4YP appointment
Riverside Surgery (Branch Surgery of Brooklea Health Centre) Wyatts View, St Anne's, BS4 4WW Open 8.30am – 6.30pm Monday, Wednesday and Thursday, 3.00pm to 6.30pm Tuesday and 8.30am - 12 noon Friday Phone 0117 972 0386 for an appointment OR just drop in and ask for a 4YP appointment
BROADMEAD Broadmead Medical Centre Inside Boots the Chemists, The Galleries, BS1 3EA Open 8.00am - 8.00pm Monday to Friday Phone 0117 954 9828 or 0333 200 5333 for an appointment OR just drop in and ask for a 4YP appointment
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CLIFTON Whiteladies Medical Group Whiteladies Health Centre, Whatley Road, Clifton, Bristol BS8 2PU Open 8.00am – 12.30 p.m. and 1.30 p.m. - 6.30pm Monday to Friday Phone 0117 973 1201 for an appointment OR just drop in and ask for a 4YP appointment
EASTON Seymour Medical Practice Charlotte Keel Health Centre, Seymour Road, Easton, Bristol BS5 0UA Open 8.30am – 12.30 pm and 1.30 - 6.30pm Monday to Friday Phone 0117 902 7155 for an appointment OR just drop in and ask for a 4YP appointment
EASTVILLE Eastville Medical Practice East Park, Eastville, Bristol BS5 6YA Open 8.30am - 6.30pm Monday to Friday Phone 0117 902 6751 for an appointment OR just drop in and ask for a 4YP appointment
FISHPONDS Fishponds Family Practice Fishponds Family Practice, Fishponds Primary Care Centre Beechwood Road, Fishponds, Bristol BS16 3TD Open 8.30am – 7.30pm Monday, Tuesday and Thursday; 7.15am - 6.45pm Wednesday and Friday; 8.30am - 10.00am Saturday Phone 0117 908 2365 for an appointment OR just drop in and ask for a 4YP appointment
Old School Surgery Manor Road, Fishponds, Bristol BS16 2JD Open 8.30am – 1.00pm and 2.00pm – 6.30pm. Monday to Friday Phone 0117 965 3102 for an appointment OR just drop in and ask for a 4YP appointment
HARTCLIFFE Hartwood Practice Hartcliffe Health Centre, Hareclive Road, Hartcliffe, Bristol BS13 0JP Open 8.30 am – 12.30 pm and 1.30pm - 6.15pm Monday to Friday Phone 0117 3015 226 for an appointment OR just drop in and ask for a 4YP appointment
HENBURY Willow Tree Surgery (Southmead & Henbury Family Practice) 1 Trevelyan Walk, Henbury, BS10 7NY Open 8.30am to 12.30pm Monday to Friday. For afternoon opening times click here . Phone 0117 950 7750 for an appointment OR just drop in and ask for a 4YP appointment
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HENBURY (con’t) Bradgate Surgery Ardenton Walk, Brentry, Bristol BS10 6SP Open 8.00am to 6.30pm Phone 0117 959 1920 for an appointment OR just drop in and ask for a 4YP appointment
HORFIELD Horfield Health Centre Lockleaze Road, Horfield, BS7 8RR Open 8.30 am – 6.30 pm Monday to Friday Phone 0117 969 5391 for an appointment OR just drop in and ask for a 4YP appointment
Gloucester Road Medical Centre Tramway house, 1a Church Road, Horfield, BS7 8SA Open 8.15 am – 7 pm Monday to Thursday, 8.15 am - 6.30 pm Friday Phone 0117 949 9924 for an appointment OR just drop in and ask for a 4YP appointment
KNOWLE WEST Merrywood Practice William Budd Health Centre, Knowle West Health Park, Downton Road, BS4 1WH Open 8.30 am – 12.15 pm and 1.15 pm – 6.30 pm Monday to Friday Phone 0117 944 9750 for an appointment Or just drop in and ask for a 4YP appointment
LAWRENCE HILL Lawrence Hill Health Centre Hassell Drive, Easton, Bristol BS2 0AN Open 8:00am - 7.30pm Monday and Thursday; 8:00am - 7.00pm Tuesday and Wednesday; 8:00am - 6.30pm Friday; and 11th July 2009 and every other Saturday after that: 8am - 10am Phone 0117 954 3060 for an appointment OR just drop in and ask for a 4YP appointment
Wellspring Surgery Beam Street, Redfield, BS5 9QY Open 8:00am - 1:00pm and 2:00pm - 6:30pm Monday – Friday Phone 0117 9557474 for an appointment OR just drop in and ask for a 4YP appointment
LAWRENCE WESTON Ridingleaze Medical Centre Ridingleaze, Bristol, BS11 0QE Open 8:30am - 12:30pm and 13:30pm - 6:30pm Monday – Friday Phone: 0117 9822693 for an appointment OR just drop in and ask for a 4YP appointment
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SEA MILLS Sea Mills Surgery 2 Riverleaze, Sea Mills, Bristol BS9 2HL Open: 8:30am - 6:30pm Monday to Friday Phone 0117 968 1182 for an appointment OR just drop in and ask for a 4YP appointment
SHIREHAMPTON Shirehampton Health Centre Pembroke Road, Shirehampton, BS11 9SB Open 8:30am - 12:30pm and 1.30pm - 6.30pm Monday to Friday Phone 0117 916 2226 for an appointment OR just drop in and ask for a 4YP appointment
SOUTHMEAD Southmead Health Centre (Southmead & Henbury Family Practice) Ullswater Road, Southmead, Bristol, BS10 6DF Open 8.00am - 7.00pm Monday -Friday Phone 0117 950 7150 for an appointment OR just drop in and ask for a 4YP appointment
Greenway Community Practice Greystoke Ave, Southmead, BS10 6AF Open 8:30am to 7:00pm Monday to Friday Phone 0117 959 8939 for an appointment OR just drop in and ask for a 4YP appointment
WESTBURY The Westbury-on-Trym Primary Care Centre Westbury Hill, Westbury-on-Trym, Bristol, BS9 3AA Open 8.30 am - 11.30am and 2.00 pm to 6.00 pm Monday to Friday Phone 0117 962 3406 for an appointment OR just drop in and ask for a 4YP appointment
WHITCHURCH Whitchurch Health Centre (Armada Practice) Armada Road, Whitchurch BS14 0SU Open 8.30am - 6.30pm Monday - Friday Phone 01275 839 421 for an appointment OR just drop in and ask for a 4YP appointment
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Brook Young People’s Clinic Outreach Team
SEXUAL HEALTH DROP-INS
Ashton Park School Wednesday 12:00 - 2:30
Bedminster Down School Tuesday 11.30 - 2.00
Bridge Learning Campus (Hartcliffe) Tuesday 12:00 - 3.30
Brightstowe Oasis Academy Thursday 12:00 - 3.30
Brislington Enterprise College Tuesday 10:45 - 3.00
Bristol Brunel Academy (Speedwell) Friday 12:00 - 2:30
Bristol Metropolitan College (Fishponds) Wednesday 10.30 - 2:30
City Academy Tuesday 12.00 - 2:30
COBC Bedminster Wednesday 12:15 - 2:15
COBC Bridge (Hartcliffe) Monday 12.00 – 2.00
Cotham Friday 12:00 – 2:00
Fairfield High School Monday 12:00 - 2.30
Florence Brown Tuesday 9:15 – 10:15
Henbury School Friday 11:30 - 2:15
Oasis Academy (Hengrove) Monday 12:00 – 3:00
Merchants' Academy Thursday 11:00 - 2:00
St Matthias Monday 10.00 - 12:30
The Meriton Thursday 11:30 - 2.30
The Orchard (Monks Park) Thursday 12:00 - 2:30
The Park Wednesday 10:00 - 12:00
Whitehouse Centre Thursday 9:00 - 10:45 We can provide relationship advice and support, condoms, pregnancy testing and referral, hormonal contraception including emergency hormonal contraception, STI testing, treatment and follow up. BROOK OUTREACH TELEPHONE: 0117 945 0728
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SAFEGUARDING CHILDREN CONTACT NUMBERS FOR BRISTOL (June 2010)
TELEPHONE NUMBERS FOR URGENT ADVICE, SUPPORT AND REFERRALS :
CHILDREN AND YOUNG PEOPLE’S SERVICES (use office nearest to the child’s address) Ridingleaze House, Lawrence Weston (North) 0117 903 8700
Symes House, Hartcliffe (South) 0117 353 2200
Broadwalk, Knowle (South) 0117 9031414
Welsman, St Pauls (East/Central) 0117 903 6500
Out of hours emergency duty team (after 5pm and w/e) 01454 615165 CHILD PROTECTION PLAN (to check if child is subject to 0117 903 7774 (daytime) one) 01454 615165 (out of hours)
FOR 24 HOUR URGENT ADVICE AND SUPPORT: COMMUNITY PAEDIATRICIANS (ask to speak to on-call paediatrician for child protection) Contactable via UHB switchboard 0117 923 0000
Telephone numbers for routine advice and support: NHS BRISTOL and BRISTOL COMMUNITY HEALTH Designated Doctor for all Dr Jane Schulte Bristol Trusts and NHS South South Plaza Gloucestershire Tel: 07823 533889, Email: [email protected] Jackie Mathers Designated Nurse for 4th Floor, South Plaza, Safeguarding Children Tel: 0117 9002670, Email: [email protected] Pam Young Named Nurse for Safeguarding 6th Floor, South Plaza Children Tel: 0117 9841563, Email: [email protected] Dr Wanda Owen Named Doctor for St George Health Centre Safeguarding Children Tel: 0117 9612161 Email: [email protected]
BRISTOL PCT MARAC NURSE 0117 9002474
CHILD PROTECTION TEAM FOR POLICE 0117 9454320 ACUTE POLICE ASSISTANCE 0845 4567000 ONLINE INFORMATION South West Child Protection Procedures available at www.swcpp.org.uk January 2010, Due for next review: January 2012 (unless new recommendations are issued before this date. ) 545454of54 of 555555 pages
CONTACT NUMBERS FOR NEIGHBOURING TRUSTS North Bristol NHS Trust (NBT) Anne Fry Named Nurse for Child The Children’s Centre, Frenchay Hospital Protection Tel: 0117 9752997 Email: [email protected] Rachel Fielding Named Midwife for Child Midwifery Unit, Southmead Hospital Protection Tel: 0117 9595301 Email: [email protected] Dr Lindsey Mackintosh Westgate House, Southmead Hospital Named Doctor for Child Tel: 0117 9595355, Email: [email protected] Protection Dr Maria Bredow 2nd Floor, Cossham Memorial Hospital Tel: 0117 3408080, Email: [email protected] University Hospitals Bristol NHS Foundation Trust (UHB) Carol Sawkins Named Nurse for Child Child Protection Team Office, Level C, St Michael’s Hospital Protection Tel: 0117 3425269 Email: [email protected] Sarah Windfeld Named Midwife for Child St Michael’s Hospital Protection Tel: 0117 9215411 Email: [email protected] Dr Lisa Goldsworthy Named Doctor for Child Bristol Children’s Hospital Protection Tel: 0117 3428188 Email: [email protected] NHS South Gloucestershire Cindy Chesterman Lead Manager for Safeguarding Building 8, Brook Office Park, Folly Brook Lane, Emerson’s Green Children Tel: 0117 3302406 Email: [email protected] Named Doctor for Child Vacant Protection NHS North Somerset Pat Richards Designated Nurse for Child Waverley House, Old Church Road, Clevedon Protection Tel: 01275 546713 Email: [email protected] Jocelyn Grimwood Named Nurse for Safeguarding Worle Health Centre, 125 High Street, Worle Children Tel: 01934 529158 Email: [email protected] Dr Mike Pimm Named Doctor for Child Cedars Surgery, Weston-super-Mare Protection Tel: 01934 515878 Email: [email protected]
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