Pharmacy Needle and Syringe Programme Enhanced Contract 1 st April 2012 31 st March 2013 Signed on behalf of LPC Signed on behalf of CRI Signed on behalf of Turning Point Signed on behalf of KCA Signed on behalf of KDAAT Signed on behalf of Medway DAAT... KENT LOCAL PHARMACEUTICAL COMMITTEE 1
THE PHARMACY NEEDLE AND SYRINGE PROGRAMME 1.0 Introduction 1.1 The community pharmacy contract, which came into effect on April 1 st 2005, is made up of three service levels. These are essential services, advanced services and enhanced services. Contractors will be in a position to tender for enhanced services that are commissioned by their local Primary Care Trusts (PCT s). This enhanced service specification outlines the specialised services to be provided by pharmacy contractors. 2.0 Background 2.1 There is good evidence that community pharmacy based needle exchange services can complement and support other needle exchange and harm reduction initiatives commissioned by drug treatment agencies 1. The National Institute for Health and Clinical Excellence (NICE 2009) recommends that a mix of generic and targeted needle syringe exchange services should be available to meet local need. 3.0 Service Aims and Objectives 3.1 To enable the service user to remain healthy until they are ready and willing to cease injecting and ultimately achieve a drug-free life with appropriate support 2. 3.2 To protect health and reduce the rate of blood-borne viruses and drug related deaths among service users by: reducing the rate of high risk injecting behaviors such as sharing drug equipment/paraphernalia providing sterile injecting equipment and advice promoting safer injecting practices through training and education providing and reinforcing harm reduction messages including safe sex advice and advice on overdose prevention (e.g. risks of poly-drug use and alcohol use). 1 National Institute for Health and Clinical Excellence (2009) Needle and syringe programmes: providing people who inject drugs with injecting equipment. 2 Pharmaceutical Services Negotiating Committee (PSNC) Enhanced services Contract EN2 Needle & Syringe Exchange 2
3.3 To improve the health of local communities by preventing the spread of blood borne viruses by ensuring the safe disposal of used injecting equipment. 3.4 To ensure service users are able to access treatment by offering referral to specialist drug and alcohol treatment centers, or health and social care professionals where appropriate. 3.5 To improve access to specialist treatment for all injecting drug users particularly the hard to reach and socially excluded groups through improved care pathways and close partnership working. 3.6 To ensure service users are able to access other health and social care provision and to become part of the pathway into other services (e.g. primary care, specialist prescribing, hepatitis B immunization, hepatitis and HIV screening etc). 3.7 To deliver consistent needle exchange provision across Kent so that service users in all parts of Kent have access to an equitable level of care and facilities. A universal service will ensure an increased number of pharmacy premises participate in the scheme. 4.0 Service outline 4.1 The pharmacy should ensure that there is an area with a sufficient level of privacy and safety for service users, other users of the pharmacy and the staff for the delivery of this service. 4.2 The pharmacy contractor has a duty to ensure that pharmacists and staff involved in the provision of the service have relevant knowledge and are appropriately trained in the operation of the service. The NICE guidance (2009) recommends that pharmacy staff should: be able to provide advice on how to dispose of needles and syringes safely receive awareness training on the need for discretion and the need to respect the privacy of people who inject drugs be trained to provide health promotion advice (in particular, advice on how to reduce harm by injecting) have health and safety training have access to Hepatitis B vaccination understand the care pathways for injecting drug users and have a knowledge of specialist services available for further support 3
4.3 The pharmacy contractor has a duty to ensure that pharmacists and staff involved in the provision of the services are aware of and operate within any agreed national guidance and local protocols. 4.4 The pharmacy will allocate a safe place to store syringe exchange equipment and returns for safe onward disposal. The storage containers provided by KDAAT commissioned clinical waste disposal service will be used to store returned used equipment. The pharmacy must comply with the Non-Waste framework directive. 4.5 The pharmacy contractor should ensure that staff are made aware of the risks associated with the handling of returned used equipment and the correct procedures used to minimize any risk. A needle stick injury procedure must be in place. 4.6 Appropriate protective equipment, including gloves, and materials to deal with any spillages, should be readily available and close to the storage site. 4.7 The pharmacy should maintain appropriate anonymised records to ensure effective ongoing service delivery and audit. 4.8 The service provider will ensure the pharmacy has a framework for the recording of relevant service information for the purposes of audit and the claiming of payment. 4.9 The pharmacy should clearly display (the national or local scheme logo) indicating participation in the service. 4.10 Kent Drug and Alcohol Action Team (KDAAT) will ensure that the service providers commissioned will supply the exchange packs and associated materials and provide a clinical waste disposal service for each participating pharmacy. The frequency of waste collection should be agreed to ensure there is not an unacceptable build up of clinical waste on the pharmacy premises. 4.11 The provider will need to give details of relevant referral points, which pharmacy staff can use to signpost service users who require further specialised services and/or support. 4.12 The provider should make available any relevant health promotion/guidance material to pharmacies to distribute to service users when necessary. 4
4.13 Pharmacy staff will enquire whether the client is returning used injecting equipment in an appropriate container. Pharmacy staff will make (insert contract holder) aware of any clients with a record of non-returns. 4.14 Service users who are under 18 years of age should be referred to KCA Young People s services (East Kent: tel. 01227 456744, West Kent: tel. 01634 338640). Should the service user appear to be under 18 years of age the pharmacist should ask for proof of their age to prevent confusion (This will safeguard both the pharmacy staff and the clients). If the service user s age was checked and the pharmacist was satisfied that the service user is over 18, it is advised that a note should be made in the pharmacy/branch diary together with a brief description of the type of identification seen. There is no need to record the service user s name. 5.0 Accreditation 5.1 The needle and syringe exchange scheme must be provided under the supervision of the pharmacist. Pharmacists and one counter staff members participating in the scheme will be expected to attend one contractor meeting organized by KCA (UK) and Turning Point to promote service development, share experiences and update the knowledge of pharmacy staff. Pharmacists must also be undertaking or have successfully completed the CPPE Substance Use and Misuse Open Learning Programme (10 Hours) in line with the HAG Competencies and Training Framework. 3 6.0 Payment 6.1 Payments to pharmacists will comprise of an annual retainer fee and a fee per service user visit. Payment will be dependent on one pharmacist and one counter staff attending one contractor meeting per year at a mutual convenient venue. Annual retainer fee 510 Needle and Syringe transaction fee 1.60 7.0 Audit 7.1 The pharmacist will be required to record service level activity below on an agreed form monthly. The recording will include each service user and 3. HAG Competencies & Training Framework 2010 5
the times they have revisited the syringe exchange scheme. 1 Type of drug injected 2 Gender 3 Service user initials 4 Client number 5 Client engagement in treatment 6 Date of supply of pack 7 No. of packs supplied 8 Type of pack supplied 9 Number of sharps returns/non returns 8.0 References 1. National Institute for Health and Clinical Excellence (2009) Needle and syringe programmes: providing people who inject drugs with injecting equipment. http://www.nice.org.uk/nicemedia/pdf/ph18guidance.pdf 2. Pharmaceutical Services Negotiating Committee (PSNC) Enhanced services Contract EN2 Needle & Syringe Exchange http://www.psnc.org.uk/data/files/pharmacycontract/enhanced_service_s pec/en2.doc 3. HAG Competencies & Training Framework http://www.primarycarecommissioning.nhs.uk/200.php 6