Telford & Wrekin Pharmacy LES Chlamydia Screening Page 1 of 16

Transcription

1 NATIONAL CHLAMYDIA SCREENING PROGRAMME LOCAL ENHANCED SERVICE (LES) SPECIFICATION FOR OPPORTUNISTIC CHLAMYDIA SCREENING PILOT IN PHARMACY April 2010 Telford & Wrekin Pharmacy LES Chlamydia Screening Page 1 of 16

2 Contents 1 Background 3 2 Service Description 3 3 Aims of the Chlamydia screening programme 4 4 Intended Service Outcomes 4 5 Clinical governance 4 6 Service outline 5 7 Eligibility to provide the service 6 8 PCT & Chlamydia Screening Office Agreement 7 9 Management of patients 7 10 Audit requirements 7 11 Payments 8 12 Training and development 8 Appendix1 Service Level Agreement Appendix 2 Chlamydia screening programme inclusion and exclusion criteria Appendix 3 Screening flow chart Appendix 4 Key Contacts Appendix 5 - Chlamydia Screening Claim form. Telford & Wrekin Pharmacy LES Chlamydia Screening Page 2 of 16

3 1 BACKGROUND 1.1 Sexual ill health has broad social and economic cost for the individual and society. With the prevention of sexual ill health having the significant potential to improve health and reduce health inequalities. 1.2 Genital Chlamydia trachomatis infection is the sexually transmitted infection most frequently diagnosed in genitourinary medicine (GUM) clinics in England. Prevalence of infection is highest in sexually active young men and women, especially those aged less than 25 years. Untreated infection can have serious long-term consequences, particularly for women, in whom it can lead to pelvic inflammatory disease (PID), ectopic pregnancy and tubal factor infertility. Since many infections are asymptomatic (least 80% of women and 50% of men), a large proportion of cases remain undiagnosed, although infection can be diagnosed easily and effectively treated. 1.3 Chlamydia screening is currently carried out across England as part of the National Chlamydia Screening Programme (NCSP). The objective of the programme is to control Chlamydia through the early detection and treatment of asymptomatic infection, preventing the development of sequelea and reducing onward transmission of the infection. The aim is a multi-faceted, evidence based and cost effective national prevention programme in which all sexually active young men and women under 25 years of age and those under 16 years of age deemed Fraser competent are aware of Chlamydia, its effects, and have access to services providing screening, prevention and treatment to reduce their risk of infection, the development of untoward sequelae and onward transmission. An opportunistic approach is used bringing on board a diverse combination of healthcare and non-healthcare screening venues to deliver the programme. 1.4 This Local Enhanced Service (LES) is designed to increase planned and opportunistic Chlamydia screening in community pharmacy. 2 SERVICE DESCRIPTION 2.1 Chlamydia screening kits will be available from selected pharmacy pilot sites. 2.2 Community pharmacies will pro-actively offer and encourage uptake of postal Chlamydia screening kits as a minimum to all eligible clients presenting for Emergency Hormonal Contraception. However, the aim is that screening kits will be offered to all sexually active males and females under the age of 25 when attending the pharmacy for such things as condoms, dispensing oral contraceptive pills or pregnancy testing. 2.3 Community pharmacies will provide advice on how to utilise the kit, how to return it for testing and what will happen following completion of the test in line with the approach adopted by the local Chlamydia Screening Programme. The service will form part of the locally run NCSP. 2.4 Community pharmacies will pro-actively offer the postal Chlamydia screening packs, encourage uptake through counselling the client in line with approach adopted by CSC and offer the option of treatment in line with agreed PGD. 2.5 Community pharmacies will offer a user-friendly, non-judgmental, client-centred and confidential service. 2.6 Community pharmacies will link into existing local networks of sexual health and community contraceptive services so that there is a robust and rapid referral pathway for Telford & Wrekin Pharmacy LES Chlamydia Screening Page 3 of 16

4 people who need onward signposting to services that provide on-going contraception, for example long acting reversible contraception (LARC) and diagnosis and management of sexually transmitted infections (STIs). 2.7 Community pharmacies will provide support and advice to people accessing the service, including advice on safer sex, advice on the use of regular contraceptive methods and signposting to other sexual health services, when required. 3 AIMS OF CHLAMYDIA SCREENING IN PHARMACIES 3.1 The overall aim of the Pharmacy Chlamydia Screening Programme (CSP) within Telford & Wrekin is to; To increase screening of sexually active men and women under 25 years for Chlamydia infection. To increase range of primary care settings offering Chlamydia screening To reach sexually active young men and women who do not use mainstream sexual health services. To increase opportunistic screening of asymptomatic patients consulting for unrelated reasons in community pharmacy. To increase acceptability of screening for Chlamydia. To increase understanding and awareness of the importance of Chlamydia infections in sexually active young people. To de-stigmatise Chlamydia infections and raise awareness of positive sexual health. To reduce the burden on secondary care services by diagnosing and treating infections in the community. To increase early detection and treatment of both Chlamydia and therefore reduce transmission and complications associated with these infections. 4 INTENDED SERVICE OUTCOMES 4.1 The aims detailed above will be measured through the following indicators; Nos of screens generated through community pharmacy settings amongst: o those accessing for EHC o those accessing opportunistically Improved access to Chlamydia screening and treatment for eligible young people aged under 25 yrs (see Appendix 2 for inclusion criteria) and those testing positive. Increased awareness of the CSP and general sexual health services within Telford & Wrekin. Increased awareness of Chlamydia and other sexually transmitted infections. Promotion of positive sexual health. Increase the range of sexual health services provided by community pharmacy 5 CLINICAL GOVERNANCE 5.1 The local CSP has a formal structure in place for the management of results. Each community pharmacy will need a dedicated contact within the pharmacy that will lead the Chlamydia screening LES. 5.2 The CSP (through the lead commissioner) will contact the community pharmacy monthly to review the number of distributed and completed postal kits. 5.3 The Telford & Wrekin CSP will report to the Chlamydia Screening Group on the number of: Telford & Wrekin Pharmacy LES Chlamydia Screening Page 4 of 16

5 Screening kits distributed Completed screening kits within the pharmacy Treatments provided Profile of activity by age, gender, ethnicity, postcode Reason screening kit offered 5.4 All community pharmacies will register on-line and start completion of the self assessment toolkit for the You re Welcome Quality Standards during the period of this LES. 5.5 All community pharmacies will adhere to multi-agency referral procedures for safeguarding children and young people. 5.6 Details of Inclusion Criteria can be found Appendix Management flowcharts Appendix 3. 6 SERVICE OUTLINE 6.1 The availability of Chlamydia screening kits within the pharmacy will be promoted through the display of agreed promotional materials by the pharmacy. 6.2 All clients presenting to the community pharmacy for EHC in the under 25 age group will be routinely offered and encouraged to undertake a Chlamydia screen. 6.3 In addition, community pharmacies will promote / provide opportunistic Chlamydia screening to eligible individuals who: request screening kits in response to local advertising access the pharmacy for other sexual health/contraception services eg. condoms, pregnancy testing, oral contraceptive pill etc. 6.4 Community pharmacies will be expected to offer the following; Routinely offer Chlamydia screening kits to all clients under 25 presenting for EHC and opportunistically to both young men and women aged under 25 years presenting for other services as set out in 6.3 above If the client opts for Chlamydia screening, the pharmacy is expected to ensure the client is clear on how to complete and return the kit to encourage completion of the screening kit The completed screening kit involves providing a urine sample for women or men. The client can opt to send the screening kit to the PRH laboratory themselves (envelope provided). However, Community pharmacies are strongly encouraged to get clients to complete the Chlamydia screening kit and return it to the pharmacy (wherever possible) Ensure all completed screening kits returned to the pharmacy are posted for analysis to the Microbiology Laboratory at Princess Royal Hospital Hold pharmaceutical stock in line with service requirements Signpost young people to other Contraceptive and Sexual Health services across Telford & Wrekin. Telford & Wrekin Pharmacy LES Chlamydia Screening Page 5 of 16

6 ELIGIBILITY TO PROVIDE THE SERVICE 6.5 For the pharmacy to participate in the Chlamydia screening LES pilot it must adhere to the following requirements: Provide a named Chlamydia lead to link with the lead commissioner. Prominent display of patient promotional material in the pharmacy window and store (display materials provided by the lead commissioner). Pharmacy staff to have completed the PCT Chlamydia screening training before commencement of the service. Training should be then cascaded to relevant pharmacy personnel including counter staff, and a record of cascade training kept. Pharmacy staff trained to deliver the Chlamydia screening and treatment service are expected to complete the on line CPPE sexual health course. Develop mechanisms to opportunistically flag individuals under 25 eligible for screening. Include counter staff in raising awareness of the screening programme so that promotion of screening kits can be linked to all under 25s, through dispensing of the oral contraception, condoms, pregnancy testing. Order and maintain appropriate supplies. Be familiar with how to store and transport completed Chlamydia screening kits in a safe way. Be competent in issuing screening kits ie:- o Correct completion of form(s) (as set out in appendix 3) o Providing information on:- receiving results how to prevent infection the need for re-screening on an annual basis or with each new partner. Provide literature to patients requiring information on: Chlamydia, and on alternate locations where comprehensive screening and sexual health services are offered. Keep accurate records of all screening kits distributed as well as those completed kits returned to the pharmacy. Submit a claim form each month to the PCT lead commissioner which details the number of kits distributed, the number of kits returned to the pharmacy and the number of treatments provided (where applicable) in an accurate and timely manner. No later than the 5th of the following month (Appendix 5). The aim is for the community pharmacies to reach at least 50% return rate on all distributed Chlamydia screening postal kits. Collection of additional data as required by the Chlamydia Screening Programme (CSP). Telford & Wrekin Pharmacy LES Chlamydia Screening Page 6 of 16

7 7 PCT AGREEMENT The PCT will; Provide complete Chlamydia screening packs and treatment packs to participating community pharmacies. Provide pharmacies with all Chlamydia screening programme promotional material on a timely basis. Provide a contact for any queries relating to the operating of this service. Provide training sessions for community pharmacies on a group and individual basis as required. Provide a framework for the recording of relevant service information for the purposes of audit and the claiming of payment. Payment for the completed screening kits will be calculated by the lead commissioner based on data returns from the pharmacy and the number of completed screens received by the PRH laboratory. Effect prompt payment in line with existing free EHC for under 19 s in pharmacy model. 8 MANAGEMENT OF PATIENTS 8.1 Participating pharmacies are expected to use the NCSP test request forms only and send specimens through the post directly to the microbiology laboratory at PRH Telford for processing where the client has returned the completed kit to the pharmacy. 8.2 The microbiology laboratory will send all results directly to B-clear. (B-clear deal with the information management side of the programme: results, the web site etc). B-clear will notify the patient directly with the screen result and give them options to access treatment if the result is positive. One of these options will be the originating community pharmacy. 8.3 Community pharmacies are not expected to develop a system to manage results. The local CSP team and B-clear will manage client results, treatment and partner notification. 8.4 All partner notification will be undertaken by the Community Health Advisor. Any pharmacist providing treatment will be expected to provide the client with contact slips (for partners), discuss the importance of informing contacts, and refer them to the CHA for further follow up. 9 AUDIT REQUIREMENTS 9.1 The pharmacy should use the claim form (Appendix 5) to collect data and ensure that all collated information is returned by 5 th of the following month to the following address; Emma Pyrah Joint Commissioning Team Children & Young People Edward James House Hadley Park Hadley Telford TF1 6QJ Telford & Wrekin Pharmacy LES Chlamydia Screening Page 7 of 16

8 9.2 All pharmacies must record: For both distributed and returned screening kits data should be collected on; Date handed out/returned Gender of person kit distributed to Age Postcode (at least first 3 digits but preferably all) Ethnicity Whether kit was requested by client OTC or as a result of consultation Reason client presenting/screening kit offered 9.3 The number of test kits received at the laboratory will be counted centrally by the lead commissioner and figures will be collated detailing how many kits have been received from each participating pharmacy. These figures will be used to determine payment of the number of completed Chlamydia Screening kits. 9.4 The aim is that at least 50% of the distributed kits will be completed and sent back to the laboratory. 10 PAYMENT 10.1 The Service Level Agreement is effective from 1 st April 2010 to 31 st March Payment will be structured as follows; will be paid to the pharmacy for the distribution of each Chlamydia screening kit to any applicable young person (aged years.) resident in Telford & Wrekin. This will be collated by the pharmacy completing the claim form (Appendix 5) and returning it to the CSC no later than the 5 th of the following month will be paid to the pharmacy for each completed Chlamydia screening kit (i.e. paperwork fully completed, including patient contact information, completed urine sample) received by PRH laboratory will be paid to the pharmacy for each treatment consultation provided as a result of a positive diagnosis from screens originating from the pharmacy plus reimbursement of the drug tariff It is the responsibility of the pharmacy to ensure that all kits contain the DOH Chlamydia screening site code/name on the microbiology form (completed predominantly by the young person.) Calculation of the number of completed screens received by the laboratory will be completed by the Chlamydia screening office. Pharmacies will not be paid for any screens completed in individuals aged under 15 years and over 24 years (unless they are the contact of a Chlamydia positive case) or whose postcode is outside of the Telford & Wrekin PCT boundary. 11 TRAINING AND DEVELOPMENT 11.1 The pharmacy named lead and key pharmacy staff should attend training and be responsible for cascading information and training to other staff members (including locum pharmacists) involved in the provision of this Chlamydia screening LES. Telford & Wrekin Pharmacy LES Chlamydia Screening Page 8 of 16

9 11.2 Chlamydia screening LES training and updates will be offered through the Telford & Wrekin CSP. Telford & Wrekin Pharmacy LES Chlamydia Screening Page 9 of 16

10 Appendix 1 SERVICE LEVEL AGREEMENT (SLA) Local Enhanced Service for Targeted and Opportunistic Chlamydia Screening in Pharmacy for sexually active men and women between 15 and 24 years of age SECTION 1 Pharmacy Name: Pharmacy Address: Pharmacy Precise No: Telephone and Fax No: Address: Declaration: I have read and understood the specifications for Local Enhanced Service for Chlamydia screening and agreed to participate as per attached service specification. YES / NO SECTION 2 Work to be undertaken: 1. To pro-actively distribute postal Chlamydia Screening kits to eligible sexually active young people aged under 25 years. 2. To provide information on how to complete the kit, prevent infection and the need for re-screening on an annual basis or with each new partner. 3. To provide treatment under PGD where requested by the client. 4. To collect appropriate data via CSP forms on completed tests taken as per the requirements of the National Chlamydia screening programme. 5. Submit claim form on a monthly basis to the lead commissioner, no later than the 5 th of the following month. 6. To ensure all completed screening kits returned to the pharmacy are posted to Princess Royal Hospital Microbiology laboratory. 7. To order and maintain appropriate supplies. Telford & Wrekin Pharmacy LES Chlamydia Screening Page 10 of 16

11 SECTION 3 Payments for Chlamydia screening enhanced service: 1 per screening kit distributed; plus an additional 4 for all completed kits returned to the PRH microbiology laboratory carried out in eligible under 25 year old, or a contact, as per Chlamydia screening programme plus an additional 15 for all treatment consultations provided under this pilot scheme plus reimbursement of the associated drug tariff SECTION 4 The Pharmacy named in section 1 of this document has agreed to provide the Local Enhanced Service for Chlamydia screening. This enhanced service will run from 1 st April 2010 to 31 st March Name of person completing this form: Once signed this agreement is binding for all partners in the pharmacy named in section 1. By signing this SLA pharmacy agree to provide the enhanced service as directed above during the financial year 2010/11. Pharmacy Signature: Pharmacy Position: Date of pharmacy signature: NHS Telford & Wrekin Signature: NHS Telford & Wrekin Position: Date of NHS Telford & Wrekin signature: A signed copy of this agreement will be kept by the Pharmacy and NHS Telford & Wrekin. Please return completed SLA to the following address: Emma Pyrah NHS Telford & Wrekin Joint Commissioning Team Children & Young People Edward James House Hadley Park Telford Shropshire TF1 6JQ Telford & Wrekin Pharmacy LES Chlamydia Screening Page 11 of 16

12 Appendix 2: Chlamydia Screening Programme Inclusion and Exclusion Criteria INCLUSION Any males/females aged yrs who are/ have been sexually active esp: those who have not been screened within past 12 months / those who have had a new partner since their last test Under 16 sexually active and assessed Fraser competent according to the Fraser guidelines Previously screened patients, according to risk assessment. Minimum 5 weeks between tests. Male/female (any age) who is the partner of a positive client picked up on the screening programme or has reason to believe a partner has tested positive EXCLUSION Any male/female 25 yrs old and older, who is NOT a contact of a positive Chlamydia infection identified through the screening programme All symptomatic patients Men and women who have been advised to have a diagnostic Chlamydia test. Those who cannot give consent to being screened Those unwilling to give any means of contact for their result Those under 16 years not deemed Fraser competent Men and women who have been treated for Chlamydia in the previous 5 weeks. Individuals identified as being eligible for screening should be given information to assist them to make an informed choice. Written consent for screening is not required as completing the test form implies it. Opportunity for the client to raise questions and queries with the clinician prior to screening should always be given. A point to note - if a women attends for emergency contraception within 2 weeks of episode of sexual activity and it was the first time she had sex with a new partner, or the first ever sexual activity, advise repeating the screen 2 weeks later if result is negative. Telford & Wrekin Pharmacy LES Chlamydia Screening Page 12 of 16

13 Appendix 3: Flowchart for Chlamydia screening in Pharmacy CARE PATHWAY: - HOW TO TAKE A CHLAMYDIA SCREEN IN A COMMUNITY PHARMACY SETTING The laboratory form When engaging with client, staff to explain need for core data on request form Staff to complete: Reason for test (usually screening Client to complete highlighted sections of form Date of test Name Date of birth Sex Residential postcode in Telford & Wrekin Preferred mode of contact i.e., phone number for text or call/address for letter Contact details as preferred Ethnicity Staff advise client to check highlighted parts of form completed correctly before posting sample The Sample Inform client of where toilet facilities are. Urine sample should be taken having not passed urine for ONE hour. Advise Client To read You may not know you have it leaflet from pack, prior to screening, To call B-clear / or drop back in to the pharmacy if any questions To read instruction leaflet and follow instructions for screening To return urine sample and request form in pre paid envelope Advise client of results notification process Advise client to call B-clear after 2 weeks if they haven t received their result Advise client of nearest treatment site Pharmacist to complete appropriate documentation Telford & Wrekin Pharmacy LES Chlamydia Screening Page 13 of 16

14 Appendix 4: Chlamydia Screening Programme Team Emma Pyrah Lead Commissioner Chlamydia Programme Joint Commissioning Team, Edward James House, Hadley, Telford, TF1 6QJ / emma.pyrah@telfordpct.nhs.uk Contact for all programmatic issues incl. training, supplies, publicity: andy.smith1@nhs.net David Shaw Community Health Advisor Contact for all issues relating to contact tracing & treatment of individual cases B-clear Chlamydia screening programme / Contact for all issues relating to individual client results RISQ young people s sexual health clinic o Shrewsbury: o Telford GUM clinic: o Telford: o Shrewsbury: Telford & Wrekin Pharmacy LES Chlamydia Screening Page 14 of 16

15 Screen Distributed ( 1) Telford & Wrekin Pilot Pharmacy Chlamydia Screening LES Payment Claim Form Month 2010/11 Please return by 5 th working day of the following month to Emma Pyrah, Joint Commissioning Team, Edward James House, Hadley Park, Telford, TF1 6QJ. Payments claimed on this form should relate to one calendar month as stated above Date Screen Returned ( 4) Treatment provided ( 15) Age Gender M/F Profile of client Postcode Ethnicity (classifications overleaf) Last tested for Chlamydia (if never put N) Screening in response to: EHC consultation Other consultation Request by client (RBC) due to: a) In store publicity b) Credit cards c) Mail out Example n/a n/a 17 F T F 1 6 J Q 1 3 months ago EHC n/a 22 F T F N R 1 Telford & Wrekin Pharmacy LES Chlamydia Screening Page 15 of 16

16 Declaration 1. The consultations and supplies listed on this claim form were undertaken as stated above by authorised personnel from the pharmacy following the Telford & Wrekin PGD 2. I hereby claim the stated monetary amounts as overleaf for Chlamydia testing and treatment 3. I declare that information given on this form is true to the best of my knowledge 4. I understand that action may be taken against me if I make an incorrect claim 5. I consent to the disclosure of relevant information on this form for the purposes of fraud prevention, detection and investigation Pharmacist signature: Date of signature: Pharmacy stamp Classifications for ethnicity recording White British 1. White British 2. White Irish 3. Any other White Background Mixed/Dual Heritage 4. White and Black Caribbean 5. White and Black African 6. White and Asian 7. Any other Mixed Background Asian or Asian British 8. Indian 9. Pakistani 10. Bangladeshi 11. Any other Asian background Black or Black British 12. Caribbean 13. African 14. Any other Black background Chinese or other Ethnic Group 15. Chinese 16. Yemeni 17. Travellers 18. Any other 99 Do not wish to state For accurate payments, please ensure that this stamp is legible Telford & Wrekin Pharmacy LES Chlamydia Screening Page 16 of 16