Sexual Health Services (Emergency Hormonal Contraception, Chlamydia Screening, Condom Distribution & Pregnancy Testing) in Pharmacies.

Transcription

1 Local Enhanced Service (LES) Specification for: Sexual Health Services (Emergency Hormonal Contraception, Chlamydia Screening, Condom Distribution & Pregnancy Testing) in Pharmacies. 1. Introduction 2. Contribution to Public Health 3. Aims of the Scheme 4. Scheme Objectives 5. Service Outline 6. Quality Indicators & Activity Monitoring 7. Payment 8. Termination of Agreement 9. Appendices i. Emergency Hormonal Contraception PGD ii. Chlamydia Screening LES iii. Pregnancy Testing iv. Sexual Health Consultation and Services Flow Chart 10. Signature Sheet

2 Introduction The purpose of the agreement is to outline the enhanced service for Sexual Health provision to be provided by Community Pharmacists, which is beyond the scope of essential and additional services that pharmacies are expected to provide. Pharmacies are one of the most accessible primary health care services; they are based in the heart of communities and are often the first contact a patient will make with a health care provider. 1 Pharmacies are open access; they often operate extended hours and offer an informality that puts people at ease with no need for an appointment. The Pharmacy White Paper (2008) Pharmacy in England, Building on Strengths delivering the future, highlights pharmacy s strengths and identifies potential for pharmacies to contribute to high quality patient care and improve the population s health and wellbeing. This document also recognises that pharmacies have long been providing Sexual Healthcare. Pharmacies have a key role in developing primary health care and expanding their roles to include health promotion and patient centred services such as Emergency Hormonal Contraception (EHC), Chlamydia Screening and Pregnancy Testing. Pharmacies in many areas across the country have successfully been engaged in the provision of Emergency Hormonal Contraception (EHC) and Chlamydia Screening since 2005, evaluation of these services has led the Government to publish a national template to support Chlamydia Screening in community pharmacies as part of the National Chlamydia Screening Programme 2. 1 City of Hackney NHS, Community Pharmacy Strategy 2 Pharmacy White Paper Pharmacy in England, Building on Strengths delivering the future 2008

3 Pharmacy in the future highlights a number of areas in which pharmacies can develop their role and services including: Meeting the changing needs of patients ensuring that people get the services, medicines and information that they need at a time and place that is most accessible. 3 Better access to service pharmacies can achieve this by demonstrating the diverse services and expertise that they can offer including and become increasingly involved in the promotion of good health in a variety of ways i.e. young people being able to access contraception and Chlamydia screening at a time when is most convenient and effective for them. 4 Redesigning services around the patient and their needs. 5 All the above demonstrates that pharmacies are seen as an integral part of the NHS in providing Primary Care Services, making a significant contribution to public health and reducing sexual health inequalities in Kirklees. 3 Pharmacy in the Future Pharmacy in the Future Pharmacy in the Future 2000

4 Contribution to Public Health The community pharmacist is one of the only health care professionals who has regular interactions with large numbers of people in health as well as in sickness (HEA 1994). This should provide an excellent opportunity for pharmacists to contribute to health promotion and disease prevention activities, including sexual health services in collaboration with other healthcare providers. The Wanless Report (2004) identified Public Health as the science and art of preventing disease, prolonging life and promoting health through the organised efforts and informed choices of society, organisations, public and private communities and individuals. 6 Pharmacies have been contributing to the public health of Kirklees for many years, yet still remain probably the biggest untapped resource for health improvement. This local Enhanced Service will enable pharmacies and their staff to continue and develop this excellent Public Health work and provide wider access to Sexual Health Services for the population in particular young people. 7 The Pharmacy White Paper(2008) sees pharmacies as centres promoting and supporting healthy living and health literacy, which offers patients healthy lifestyle advice and support on self care and a range of pressing public health concerns. Choosing Health through Pharmacy calls for; Pharmacists and their teams to maximise their contribution to improving health and reducing health inequalities, by further extending their roles as advocates for health. This would include offering new services and support the delivery of key messages to patients and the public 8 which would include Sexual Health. 6 Wanless Report Choosing Health Through Pharmacy 8 Pharmacy White Paper Pharmacy in England, Building on Strengths delivering the future 2008

5 Aims of the Scheme Roll out of Sexual Health Services to include: Emergency Hormonal Contraception (EHC), pregnancy testing, Chlamydia screening and Condom Distribution in community pharmacies across Kirklees. Contribute to Public Health Priorities: Reducing the under 18s conception rate by 50% by 2010, through supplying free EHC and Condoms. Teenage pregnancy and childbearing have considerable, long-term consequences for teenage parents and their children. For example, research shows that when younger adolescents give birth, they are less likely to complete high school and more likely during their lives to have a larger number of children than are nonparenting teens. Children born to younger teen mothers may also experience poorer health outcomes, lower educational attainment, and higher rates of adolescent childbearing themselves when compared to children born to older mothers (2003). Increasing the uptake of Chlamydia Screening for young people aged As many as 1 in 10 adolescent girls tested for Chlamydia is infected. Teenage girls have the highest rates of Chlamydia infection regardless of demographics or location: year old girls 46% of infections year old women 33% of infections Chlamydia infection is widespread geographically and highly prevalent among these economically disadvantaged young women between 16 and 24 years old. People infected with Chlamydia often have no symptoms therefore are often unaware they are infected and may not seek professional health care.

6 Scheme Objectives Increase awareness in particular of young people around access and availability of the sexual health services on offer in community pharmacies. Strengthen the local network of contraceptive and sexual health services and increase access to EHC, Condoms, and Pregnancy Tests especially to young women within Kirklees PCT thereby decreasing the number of unwanted pregnancies. Increase the uptake of Chlamydia screening for young people (in particular those young women obtaining EHC and Pregnancy Testing) aged Increase access to mainstream Services and link into existing networks for community contraception services, included GPs registered with LARC, other GPS and CASH Services, where young people in particular feel comfortable to access them. Must link in with GUM services and tier two community services for further advice and diagnosis and treatment for STIs Signpost young people to treatment and follow up support services as required. Increase knowledge around consequences of risky sexual behavior by providing information and advice as appropriate on sexual health issues such as, STI s, delaying sex etc Increase the Public Health role of the Community Pharmacist and promote multidisciplinary working in relation to sexual health.

7 Service Outline a. Responsibilities of the service provider: 1. Pharmacists will provide Sexual Health Services to clients across Kirklees and they will maintain high standards of service within the clinical governance framework as set out in essential service 8 of the community pharmacy contract. 2. Pharmacists will provide sexual health consultation to clients across Kirklees and where appropriate EHC (using PGD), pregnancy testing, Chlamydia screening and condoms in line with the attached specifications. See appendix iv for flowchart. 3. Must explain the services on offer to the client conduct an interview using the appropriate pro forma, screening template or interview questionnaire. 4. Ensure that the premises are of a high standard and that a private consultation room is available to maintain levels of privacy and confidentiality. 5. Develop and maintain links with existing community contraceptive services to ensure clients have an effective referral route to CASH or GP Services. 6. Pharmacies will promote Sexual Health Services to increase access and awareness appropriate to client group. 7. Display and appropriate provision of patient information e.g. leaflets and posters in the waiting areas and support and advise clients accessing the service on improving and maintaining good sexual health, information should include; Delay, training to help young people delay early sex and 2 nd pregnancies Avoidance of pregnancy and Sexually Transmitted Infections (STIs) through safer sex and condom use. Contraceptive methods including Long Acting Reversible Contraception (LARC)

8 8. All pharmacists and staff involved in the service must have undergone the appropriate training, in line with The HAG (Harmonising Accreditation Group) Community Pharmacy Enhanced Services, Competencies and Training Framework for provision of EHC 9 and Chlamydia Screening (Level 1) 10 which will include: PCT Workshop to enable community pharmacies to become competent to provide Sexual Health Services, (in accordance with Patient Group Direction for EHC) Working within the Kirklees Safeguarding Protocols and ensure all staff have undergone safeguarding and child protection, They must be fully confident with the safeguarding procedure and know who the PCT s, Safeguarding/child protection lead is. Specific service related training provided by the PCT this will include Relationships and Sexual Health Education (RSHE) including Delay and LARC, Chlamydia Screening and condom demonstration. Information about re accreditation. 9. Staff will need to undertake regular continual professional development (CPD). 10. Ensuring that only appropriately trained and qualified staff, including locums are providing the service within the specification and PGD. 11. Ensure that all appropriate staff has undergone a CRB Check which has produced a satisfactory outcome, this will be paid for by the PCT. 12. Ensure the service that is offered is non judgmental, client centered and young people friendly 13. Provide the PCT with quarterly activity monitoring in line with quality indicators specified in this document. 14. Ensure that all information that is stored about the client is secure and all protocol around confidentiality must conform to the principles set down in the Data Protection Act and is underpinned by the systems of clinical governance 9 HAG (Harmonisation of Accreditation Group) Community Pharmacy Enhanced Services, Competences and Training Framework, Provision of Emergency Hormonal Contraception, North West Pharmacy Workforce: HAG (Harmonisation of Accreditation Group) Community Pharmacy Enhanced Services, Competences and Training Framework, Provision of a Chlamydia Screening and Treatment Service, North West Pharmacy Workforce: 2007

9 15. Service provider must notify the PCT as soon as possible if any of the Sexual Health Services are unable to be provided on a long term basis (this may be in the case of Locum cover if they have not had the necessary training). b. Recommendations for the service provider 1. Register and achieve the Kirklees Young People s Friendly Kite mark in order to encourage young people to access services, in line with the Department of Health Your Welcome Quality Criteria. 2. Support staff in developing competencies and skills in dealing with young people around sexual health e.g. Delay training supporting young people to delay early sex. PCT Responsibilities Kirklees PCT agrees to: - 1. Provide payment for all staff requiring a CRB check to deliver the Sexual Health Services. 2. Support Pharmacies by providing free training in line with the HAG Frameworks for EHC and Chlamydia Screening required by pharmacies to deliver the enhanced service, including RSHE, Delay, LARC, Chlamydia Screening and Condom Demonstration. 3. Provide appropriate documentation for the collation of Activity monitoring and payment. 4. Support and advise the promotion and publicity of the service locally and across the district, including inclusion on the Kirklees Young People s Sexual Health Website. 5. Provide up dated information about new or developing sexual health services and any service changes that may occur in order to continue effective signposting and referrals.

10 Clinical Governance PCT should ensure that clinical governance is built into contracts for pharmacy services that are commissioned locally The aim should be to ensure that clinical governance is of mutual benefit to community pharmacy and the rest of the local NHS, while improving the quality of service to patients... clinical governance in community pharmacy. The LES has considered the following issues to ensure risk reduction and safety for patients to provide the highest quality of patient care: Staff training and development Appropriate premises and resources Record keeping and patient information Privacy and confidentiality Safeguarding and child protection Further to this the standards of the Service delivered by the provider will be in line with all contractual agreements within the appropriate pharmacy contract/s and Kirklees PCT. A PGD has been written for the supply of EHC, this has been passed through medicines management and followed the standard legal procedure for PGD sign off.

11 Quality Indicators & Activity Monitoring Community pharmacies will be required to undertake monitoring activities and to report on this data using the Sexual Health Consultation Assessment Form, this will include: Number of people provided with EHC Number of people given free pregnancy tests Number of people screened for Chlamydia Number of re-users of the service. Compliance with relevant national and local data set requirements including KC60 (this is the Sexually Transmitted Infections Data set produced by the Health Protection Agency) to allow monitoring of workload activity, number of people seen within 48hrs of first contact, patient demographics and STI epidemiology The service must maintain an effective compliments, concerns and complaints procedure and a critical incidents log Regular information and feedback on user satisfaction Details of signposting to other services. Additionally, the numbers of Chlamydia screens that are positive will be fed back to pharmacies from the Chlamydia screening programme Long term we would hope to see a reduction in Chlamydia in the population and a reduction in teenage pregnancy

12 Payment Costs are broken down as follows: Consultation Fee: Chlamydia Screening: 5.00 per screen received back by the Programme Pregnancy Test: Cost of test Medical Responsibility: for EHC only Cost of EHC: Drug tariff price + VAT Dispensing fee: 2.00 For EHC only Termination of Agreement Termination of agreement can be either side giving 3 months notice in writing Agreement

13 Appendices i. Emergency Hormonal Contraception PGD Appendices ii. Chlamydia Screening LES Appendices iii. Pregnancy Testing Appendices iv. Sexual Health Consultation and Services Flow Chart

14 Please return to Sara Javid, NHS Kirklees - Public Health Department, Broad Lea House, Bradley business Park, Dyson Wood Way, Bradley, Huddersfield, HD2 1GZ Acceptance of Local Enhanced Service (LES) for Sexual Health Services (Emergency Hormonal Contraception, Chlamydia Screening, Condom Distribution & Pregnancy Testing) in Pharmacies. Pharmacy Name:.. We wish to participate in the Sexual Health Services LES, including: EHC Signature Sheet Please return this sheet to NHS Kirklees, Thank you Chlamydia Screening Pregnancy Testing We have read all the attached documents (appendices) and agree to the terms within them, all appropriate documents have been signed are included. We agree to undertake the necessary training; and record and report upon the delivered activity in order to meet the requirements of the LES and attached documents. We agree to maintain up to date knowledge and best practice for services relating to Emergency Hormonal Contraception, Chlamydia Screening, Condom Distribution & Pregnancy Testing and provide evidence of such when requested. We understand this agreement is subject to review on 31 st March Signatures.. Pharmacy Stamp