CHLAMYDIA SCREENING ENHANCED SERVICE SERVICE SPECIFICATION. Page 1 of 12

Transcription

1 CHLAMYDIA SCREENING ENHANCED SERVICE SERVICE SPECIFICATION Page 1 of 12

2 CONTENTS INTRODUCTION 3 AIMS OF THE SERVICE 4 SERVICE DETAILS 1. Who can access the service? 2. Referral into the service 3. Referral to the Patient s GP or GUM clinic 4. Consultation Process 5. Notification of results and contact tracing 6. Treatment of Infection SERVICE REQUIREMENTS 1. Who can provide the service? 2. Pharmacist and staff accreditation 3. Pharmacist and staff re-accreditation 4. Sign up and termination 5. Display 6. Record keeping 7. Payments 8. Confidentiality Appendix 1: Useful telephone numbers and background information 10 Appendix 2: Care Pathway 11 Appendix 3: Consultation Form 13 Appendix 4: Community Contraceptive Clinics 14 Appendix 5: Safeguarding Telephone Numbers 16 Page 2 of 12

3 INTRODUCTION 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. Chlamydia can also lead to infertility in men and also impaired sexual function. Chlamydia infections are asymptomatic in around 70% of women and 50% of men, therefore a large proportion of cases remain undiagnosed, although infection can be diagnosed easily and effectively treated. 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 disease. 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. The voluntary and business sectors also play a key role in delivering the NCSP. The NCSP covers the whole country and is monitored by the Health Protection Agency. National standards apply to the programme and funding has been provided to Primary Care Trusts (PCTs) to commission the service. Chlamydia Screening Offices (CSOs) coordinate the service locally across the PCT. Screening, using first-void urine samples, is initiated in a range of settings, both clinical and non-clinical. Samples are sent to a laboratory for analysis using the nucleic acid amplification test (NAAT) and the results are returned to the CSO; patients are then informed of their result and contact tracing is conducted with people with positive results and treatment is offered to people who screen positive and their partners i. Chlamydia screening within community pharmacies complements the provision of Emergency Hormonal Contraception (EHC), by offering a more holistic sexual health care service to this user group. Offering Chlamydia screening kits and condoms will also engage young men. In November 2005 a two year partnership between the Department of Health (DH) and Boots the Chemists to pilot free Chlamydia screening and treatment for year olds within the greater London area commenced. The pathfinder was independently evaluated by TNS Healthcare. The evaluation shows considerable promise with over 87% of young people reporting they would recommend the service. The evaluation is available on the DH website at: This pilot demonstrated the feasibility of pharmacies distributing Chlamydia screening kits. Page 3 of 12

4 AIMS OF THE SERVICE The service is designed to meet the following aims: To increase access to the National Chlamydia Screening Programme by providing additional locations where people can access screening. To increase access to treatment of Chlamydia infection, if deemed appropriate. Added benefits include: To increase access for young people, to sexual health advice and referral on to specialist services where required. To increase clients knowledge of the risks associated with Sexual Transmitted Infections. To strengthen the network of contraceptive and sexual health services to help provide easy and swift access to advice. SERVICE DETAILS Pharmacies will offer Chlamydia screening kits to sexually active males and females aged under 25, for example when supplying condoms, dispensing oral contraceptive pills and supplying EHC, in agreement with the local Chlamydia Screening Office. Advice on how to utilise the kit, how to compete it, return it for testing and what will happen following completion of the test will be provided in line with the approach adopted by the local Chlamydia Screening Office. Pharmacies will also be required to offer screening clients free condoms available through the EHC enhanced service via Lancashire and South Cumbria Agency (LaSCA). The service will form part of the locally run National Chlamydia Screening Programme (NCSP). In addition to the pharmacy acting as a test kit distribution service, Sexual Health advice will be provided. The management of all results, tracing and treatment will be undertaken by the Chlamydia Screening Office. 1. Who can access the service? This service will be free of charge to eligible patients and is funded by NHS Central Lancashire. 1.1 This service will be offered to any sexually active males and females aged under 25 years of age who are registered with a GP in Central Lancashire PCT. 1.2 If the patient does not meet any of the qualifying criteria, the patient cannot access the service at that time. The patient should be advised of alternative methods of accessing care in accordance with the pharmacy contract; Essential Service 6 Support for Self Care and Essential Service 5 Signposting. Patients should therefore receive brief advice, supporting patient information leaflets and or signposted to other Sexual Health service providers detailed in the back of this service spec (appendix 4) and care pathway (Appendix 2). 1.3 Patients are at liberty to refuse this service. Page 4 of 12

5 2. Referral into the service 2.1 The pharmacy Chlamydia screening service is an open referral service and therefore anyone can refer patients into the screening service including any healthcare professional, patient self referral and opportunistic recruitment by pharmacy staff. 3. Referral to the Patient s GP or GUM clinic 3.1 The following patients should be referred to their GP or the Genitourinary Medicine Clinic: Any patient over 25 years of age Any patient under 25 years of age with symptoms of a Sexual Transmitted Infection. Any patient under 16 not deemed to be Fraser competent 3.2 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 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). 4. Consultation Process 4.1 Accredited Pharmacy staff will offer a user-friendly, non-judgmental, client-centred and confidential service. 4.2 The pharmacy will offer sexually active males and females less than 25 years of age a Chlamydia screening service; the benefits of screening will be explained. People less than 16 years of age will be provided with the service if deemed Fraser competent. People over the age of 24 will be referred to services where they can be tested e.g. Genito Urinary Medicine clinics. 4.3 The service will be provided in compliance with Fraser guidance ii and Department of Health guidance on confidential sexual health advice and treatment for young people aged under 16 years iii. 4.4 Accredited staff shall, with people who verbally consent to screening, describe the screening process and how results will be communicated to the person. The person shall be supplied with a Chlamydia screening kit, supplied by the CSO (or via other locally agreed arrangements). 4.5 The part of the pharmacy used for the provision of the service must provide a sufficient level of safety and privacy (including visual privacy where appropriate), which in most circumstances will be at the level required for the provision of the Medicines Use Review service iv. Page 5 of 12

6 4.6 Pharmacies will provide support, verbal and written advice to people accessing the service, including advice on safe sex, condom use and advice on the use of regular contraceptive methods, when required. 4.7 Verbal and written advice on the avoidance of STIs and the use of regular contraceptive methods, including advice on the use of condoms v, shall be provided to the person. This should be supplemented by a referral to a service that can provide further advice and care where appropriate by the pharmacy. 5. Notification of results and contact tracing 5.1 The Chlamydia Screening Office will be responsible for notifying people of the result of screening and/or contact tracing. 6. Treatment of infection 6.1 The Chlamydia Screening Office will provide a treatment service as per the core requirements vi of the National Chlamydia Screening Programme. Page 6 of 12

7 SERVICE REQUIREMENTS The provision of this service can be divided into 4 main areas, which are described below: 1. Who can provide the service? 1.1 From 1 st December 08 to 1 st June 09The service will initially be piloted through the following 10 community pharmacies across NHS Central Lancashire. Boots The Chemists Ltd Lloyds Pharmacy Ltd Asda Pharmacy DDL Davies Ltd Parkinsons Pharmacy David Sukert AS Facer (Longton) Ltd Boots The Chemists Ltd Morrisons In Store Pharmacy Rowlands Pharmacy Fishergate, Preston PR1 3QA 112 Deepdale Road, Preston PR1 5AR Asda Superstore, Eastway, Fulwood, Preston PR2 9NP Plungington Road, Preston, PR1 7EN 97 Market Street, Chorley PR7 2SQ 2-4 Towngate, Leyland, Preston PR25 2FN Ramshead Corner, 66 Liverpool Rd, Longton, Preston PR4 5PB 20 The Concourse, Skelmersdale WN8 6ND Park Road, Ormskirk L39 3RB 123 Birleywood, Digmoor, Skelmersdale WN8 9HR 1.2 The service will be evaluated at the end of the six month pilot and if successful outcomes can be demonstrated the service will be expanded to any willing pharmacy providing the Emergency Hormonal Contraception Service. 1.3 The participating pharmacies must: o Agree with the PCT to participate in all parts of the service as detailed in this document along with any subsequent amendments as agreed with the LPC. This agreement will be in writing signed by both parties and be considered an enhanced service. o Produce a standard operating procedure (SOP) for the provision of this service, which clearly defines roles and responsibilities of relevant staff within the authorised pharmacy. o Ensure that Accredited Medicines Counter Assistant qualified staff, and above, delegated the responsibility of undertaking the screening consultation adhere to this service specification and Chlamydia screening SOP. Overall responsibility and accountability will remain with the responsible pharmacist. 2. Pharmacist and Staff accreditation 2.1 Only accredited pharmacists and accredited pharmacy staff with a Medicines Counter Assistant Qualification or above can provide this service. To gain accreditation the: A - Pharmacist must: Complete the CPPE Sexual Health testing and treating open learning pack B Medicines Counter Assistant and above must: attend a PCT evening workshop Page 7 of 12

8 2.2 The pharmacy contractor must ensure that pharmacists and staff involved in the provision of the service have relevant knowledge and are appropriately trained in the operation of the service, including sensitive, client-centred communication skills. Pharmacists and staff providing this service should also be aware of local and national guidance on safeguarding children, as it is possible that people under the age of 16 will request screening. 3. Pharmacist and staff re-accreditation 3.1 Updates are recommended every two years or as directed by the PCT, which may be in the form of a self-declaration of competency or other method of assessment as considered appropriate by the PCT. 4. Sign up and termination 4.1 All pharmacists and pharmacies must agree to the terms of service contained within this service specification/service level agreement. 4.2 Participating authorised pharmacies may withdraw from the scheme at any time and the PCT may also terminate provision from a pharmacy. Any such intention must be made in writing to the same individual identified on the Enhanced Service agreement form. A notice period of 28 days applies. 4.3 If pharmacies withdraw from the scheme, then the pharmacist authorised to provide Chlamydia screening may continue to provide the service from other authorised pharmacy premises located within Central Lancashire PCT. 4.4 Changes of ownership will require reapplication to provide the service. Changes to pharmacy staff (e.g. new manager or regular locum) who are not already accredited will require accreditation to enable continued provision of the service. 5. Display 5.1 All participating authorised pharmacies will be required to provide clearly visible and viewable dedicated space for a logo/poster indicating the availability of the service. 5.2 The PCT will coordinate the promotion of the service locally, including the development of publicity materials and the use of nationally produced materials, in order to ensure young people and other local health care providers are aware that the service is available from local pharmacies. Pharmacies should use these materials to promote the service to the public and should ensure they coordinate their promotional activities with those of the PCT. 6. Record Keeping 6.1 During each consultation the accredited staff member must complete the consultation form (appendix 3) recording the following information: Fraser Competence Inclusion criteria Patient ID (Number taken from the screening kit) Gender, Age and Ethnicity Full Postcode Consultation Date Page 8 of 12

9 6.2 Completed consultation forms must securely stored until transferred to Lancashire and South Cumbria Agency at month end for payment. 6.3 Pharmacy contractors can choose to keep a tally recording the number of consultations and screening kits supplied each month. Any such record should not contain patient identifiable data and must be for internal use only and should not be submitted to LaSCA or the PCT. 7. Payment 7.1 Pharmacy contractors will be reimbursed according to the following payment structure: A consultation fee of 4.00 per kit supplied and consultation form completed A consultation fee of 5.00 per kit supplied and consultation resulting in more than 20 postal kits being returned to the Chlamydia Screening Office per month and achieving a return rate of greater than 50% 7.2 Claims for payment should be made by the 5th working day of the following month, late submission may delay payments, by submission of the consultation form to Lancashire and South Cumbria Agency (LaSCA) at: Contractor Services Lancashire and South Cumbria Agency 3 Caxton Road Fulwood Preston PR2 9ZZ 7.3 Payments will be made at the end of the month following that to which the payment relates and can be identified from the pharmacy contractors PPA statement. 7.4 Incomplete consultation forms will be deemed invalid and as such will be returned to the contractor for resubmission or will not be processed for payment. 8. Confidentiality 8.1 All staff providing the service must have signed a confidentiality clause as determined by Essential Service 8 Clinical Governance. 8.2 Pharmacists may need to share relevant information with other health care professionals and agencies, in line with local and national confidentiality and data protection arrangements, including the need for the permission of the person to share the information Page 9 of 12

10 APPENDIX 1 USEFUL TELEPHONE NUMBERS Carolyn Blythe Chlamydia Screening Programme Co-ordinator Bridget Gray Acting Clinical Co-ordinator Sexual Health Stephen Gough Community Pharmacy Adviser Mike Hawkins Programme Support Officer Sexual Health Background information not part of the service specification The following documents and websites provide background information on Chlamydia screening and treatment: National Chlamydia Screening Programme Cumbria and Lancashire Chlamydia Screening Programmes UK National Guideline for the Management of Genital Tract Infection with Chlamydia trachomatis The Manual for Sexual Health Advisors i More information on the NCSP is available at: ii Fraser Guidelines based on a House of Lords Ruling; A health professional can give advice or treatment to a person under 16 without parental consent providing they are satisfied that; The young person will understand the advice; The young person cannot be persuaded to tell his or her parents or allow the doctor to tell them that they are seeking contraceptive advice; The young person is likely to begin or continue having unprotected sex with or without contraceptive treatment; and The young person's physical or mental health is likely to suffer unless he or she receives contraceptive advice or treatment. iii Guidance available at iv The requirements for consultation areas are detailed in The Pharmaceutical Services (Advanced and Enhances Services) (England) Directions 2005 as amended ( v Commissioners may wish to consider the inclusion of condom supply as part of the service and the integration of participating pharmacies into the local Chlamydia screening programme. vi National Chlamydia Screening Programme Core Requirements are available at Page 10 of 12

11 CENTRAL LANCASHIRE CHLAMYDIA SCREENING PROGRAMME PHARMACY PATHWAY WHAT IS THE NATIONAL CHLAMYDIA SCREENING PROGRAMME? Opportunistic screening of all sexually active men and women aged under 25 in England. Annual test or with every change of partner. PHARMACIES TO INCLUDE: All sexually active young men & women under 25 Living in Central Lancashire Not complaining of symptoms Annual check Repeat check with every change of partner REFER TO GUM CLINIC or GP: Any young person under 25 years complaining of symptoms Anyone 25 or over who is requesting Chlamydia screening REMEMBER THE PARTNERS: If partner is under 25 and living in Central Lancashire provide a best2know leaflet so that the partner can request a self testing kit to be sent to his home address via If partner is under 25 but lives outside Central Lancashire, he/she can log onto the national website to find their local service and request a self testing kit/attend for a screen. WHY IS IT IMPORTANT TO SCREEN? Approximately 1 in 10 sexually active young people under 25 years when tested will have Chlamydia. Untreated it can lead to: Pelvic Inflammatory Disease Infertility Ectopic Pregnancy Epididymitis (resulting in painful and swollen testicles) Young people under 25 years living in Central Lancashire can log onto to find out more about Chlamydia, and request a postal kit Young people under 25 years living outside Central Lancashire can log onto to find their local programme and where they can access screening Page 11 of 12

12 MANAGEMENT PATHWAY FOR CHLAMYDIA SCREENING IN PHARMACIES Explain about the National Screening Programme and offer a free self testing kit. Explain how to screen and how the young person will receive their result Assist young person to complete request form Essential - Ensure 2 legible methods of contact for result (e.g. mobile and address) Advise Not to pass urine for 2 hours before test First catch urine sample into urine pot, half full please Place urine pot into postal container To post sample in plastic envelope provided (addressed to laboratory at Royal Preston Hospital (with completed request form) Offer Supply of 6 Condoms, Relevant Information Leaflets + Sexual Health Advice END OF PHARMACY INVOLVEMENT Result sent from Laboratory to Chlamydia Screening Office Result sent to client by mobile/phone or letter as requested on lab form If result positive, appointment arranged for client and partner. Treatment and partner notification undertaken Result - Positive/Inhibitory/ Indeterminate/Leaked/ Insufficient, Text states Please call C- Wize on Negative result Text states Your C-Wize test is clear Further information on National Chlamydia Screening Programme is available on Any queries (or for further supplies of packs etc) please phone the Chlamydia Screening Team on Page 12 of 12