service specification

Authority Lead
Date of Review
Needle Exchange Programme - Sterile Works from
Oxfordshire Premises (SWOP)
Jo Melling – Head of Commissioning, Drugs and Alcohol
January 2015
1. Population Needs
1.1 National/local context and evidence base
The National Institute for Health and Clinical Excellence (NICE) Public Health Guidance
(PH18 – Needle and Syringe Programmes: Providing people who inject drugs with injecting
equipment) promotes optimal provision of needle and syringe programmes (NSPs).
Needle and syringe programmes (NSPs) supply needles and syringes and other equipment
used to prepare and take illicit drugs. They reduce the transmission of blood-borne viruses
(BBVs) including hepatitis C, and other infections caused by sharing injecting equipment and
aim to reduce the harm caused by injecting drugs through providing information and advice
and acting as a gateway to other services, including drug treatment such as opioid
substitution therapy (OST).
NSPs may be the only contact that some people, for example those who inject performance
and image-enhancing drugs [PIEDs], have with health services. NSPs in England are based
across a range of services including specialist services, pharmacies, outreach/mobile
services, police custody suites, walk-in centres and accident and emergency departments.
However, over 70% of NSPs are provided by pharmacies.
The latest data on injecting drug use suggests that the number of injecting drug users aged
between 15–64 years in England is between 115,000 and 122,000, although it could be as
high as 200,000. These include people injecting heroin, other opiate drugs or crack cocaine
and do not include people injecting PIEDs such as anabolic steroids. However, recent
anecdotal reports from across the country suggest that the use of anabolic steroids is on the
increase, particularly amongst young men1.
Needle and syringe sharing has declined in recent years. However, in 2007 almost a quarter
of respondents to the Unlinked Anonymous Prevalence Monitoring Programme reported
sharing needles and syringes during the previous 4 weeks. In addition, almost half reported
that they had shared filters, mixing containers and water during the same period 2.
1. Evans-Brown M, McVeigh J (2009). Anabolic steroid use in the general population of the United Kingdom. In Elite sports, doping, and
public health: Møller V, Dimeo P, McNamee M, editors. Odense, Denmark: University of Southern Denmark Press pp.75–97
2. Health Protection Agency (2008) Shooting up – infections among injecting drug users in the United Kingdom 2007. An update:
October 2008. London: Health Protection Agency
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1.2 Social Value Considerations
The Sterile Works from Oxfordshire Premises (SWOP) programme addresses priorities
which disproportionately affect socially disadvantaged communities in Oxfordshire. These
include prevention of blood borne viruses and supporting individuals to make choices to
reduce the harms caused to themselves, their families and the wider community. This
includes safer injecting practices, reduction in injecting site wounds and abscesses, and a
reduction in needle stick injuries in the general public resulting from discarded needles. The
programme also raises awareness of drug treatment services and drug related health
campaigns such as dental health.
Through the prevention of blood borne viruses and improving individual’s health in the
longer-term, the SWOP programme should improve the economic and social well-being of
Oxfordshire by keeping individuals healthier for longer and consequently decreasing demand
on health and social care services.
2. Scope
2.1 Aims and Objectives of service
The Service will contribute to the following: To assist injecting drug users to reduce the harms caused by injecting drug use until they
are ready and willing to cease injecting;
 To provide access to SWOP packs and associated materials to promote safe injecting
 To reduce transmission of infections by substance misusers;
 To offer a user-friendly, non-judgemental, patient-centred, confidential service to drug
users in their local community;
 To provide support and advice to the Service User, including referral to drug treatment
 To provide a safe disposal for used injecting equipment (works);
 To reduce the number of drug related deaths and transmission of blood borne viruses
 To reduce the risk behaviours such as sharing needles and syringes and lowering
injection frequency;
 To reduce injection-site infections and the number of attendances at accident and
emergency departments (and subsequent hospital bed-days) for injection-site infections;
 To reduce the harms caused to the wider community by drug-related litter by providing
safe disposal facilities and sharps bins;
 To reduce inequalities and improving access for people from specific groups such as
homeless people and women who inject drugs, and speedball users (people who inject
an opioid such as heroin in combination with a stimulant such as cocaine);
 Increasing Service User choice through offering flexible opening times and locations;
 Better value for money – NSPs are a cost-effective way of reducing the transmission of
BBVs and the development of injection-site infections and thereby reducing the costs of
associated health and social care services.
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2.2 Service description/pathway
The Service Provider will provide sterile injecting equipment to people who inject illicit drugs
as well as adults who inject non-prescribed performance and image-enhancing drugs
(PIEDs). Provision will be in accordance with NICE public health guidance (PH18 on needle
and syringe programmes).
2.2.1 The minimum essential criteria for delivery are to: Provide a needle and syringe exchange service, which is free of charge to Service
Users, in accordance with the SWOP Protocols in force. This Service will be confidential
and anonymous, except where a duty of care requires further information to be shared;
 Receive used works contained in personal sharps bins for safe disposal;
 Ensure robust communication with the collection and distribution company to ensure
that stock levels are maintained;
 Provide safer injecting practice and harm reduction advice to the individual, including
advice on blood-borne viruses;
 Provide steri-cups and other drug injecting paraphernalia subject to funding and
 Ensure robust communication with the Council to ensure that stock levels of additional
equipment such as steri-cups are maintained;
 Provide the following to Service Users:
 Advice and information on drugs awareness and safer injecting;
 Advice and information to prevent the transmission of blood borne viruses and
other drug misuse-related infections;
 Information on the availability of advice, information and counselling as appropriate
for viral hepatitis and HIV testing;
 Advice and support on preventing risk of overdose and drug-related death;
 Risk assessment and referral to other treatment services as appropriate;
 Information on local harm reduction workshops;
 Information on treatment and related drug service in the area.
 Promotion of harm reduction wherever possible including:
 The uptake of testing and immunisation for blood borne viruses as relevant;
 Emphasising the risks of overdose, and strategies to reduce those risks;
 Encourage people who inject drugs to use the Service on offer;
 Provide as many needles and syringes and other injecting equipment as someone
 Provide sharps bins and advice on how to dispose of equipment safely;
 Provide advice on safer injecting and ways to get help to stop using drugs or
switch to non-injecting methods;
 Display harm reduction campaign material and information as provided by the
2.2.2 Commissioner Responsibilities:
 The approved equipment contractor (currently SRCL as part of the Thames Valley
Primary Care Agency Contract) will provide the Service Provider without charge,
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packs of sterile injecting equipment;
The approved equipment provider (currently SRCL) will arrange for the collection of
used injecting equipment from the Service Provider, and its safe disposal in
accordance with current legislation, at no cost to the Service Provider;
The Council or its agent may provide without charge supplies of other associated
materials and leaflets for promoting safer injecting and harm reduction (subject to
Provide a direct point of contact for Service provision;
Provide details for referral points or signposting to other relevant services for Service
2.2.3 Monitoring
 Provide a minimum data set for each transaction which should be recorded within the
calendar month of the transaction occurring, using the web-based system provided by
the Commissioners (currently NEO), data should be input and retrievable by the Council
within 7 days of the end of the previous month;
 The Council will upload the needle exchange data to the National Drug Treatment
Needle Exchange (NEX) database;
Payments will be made according to the number of packs given out, and as such the data
entered onto this system will determine the level of payment to each Service Provider.
Where this information is not input onto the system within the required timescales this may
result in payment for those transactions not being able to be made to the Service Provider.
The information required for each transaction may be developed to reflect the Council’s
monitoring requirements along with the development of newer monitoring systems.
The Council will also monitor:
 Details of complaints
 Details of accidents/incidents directly or through the SUI systems.
2.2.4 Review and-Audit
 Service Provider shall be expected to:
o Participate in Council organised audit of Service
o Participate in National audit as relevant
o Participate in locally agreed Council assessment of Service User experience
o Demonstrate key Staff have undertaken CPD relevant to this Service
3.3 Population covered
Oxfordshire residents
3.4 Any acceptance and exclusion criteria and thresholds
The commissioning of this Service is for all injecting drug users and as relevant to noninjectors, over the age of 18 years.
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This Service allows supply of packs to 16-17 year old injecting drug users, if the Service
Provider establishes that not giving clean injecting equipment to the young person would be
of greater risk than the risks posed by continued or increased injecting drug misuse. All 1617 year old must be referred to the young people’s drug and alcohol service, currently Young
Access to the SWOP programme is voluntary and open, based on self-referral but referrals
are accepted from any other related service.
3.5 Interdependencies with other services
Due to the interdependencies with other major contracts, the delivery of this Service is only
open to Pharmacies based in Oxfordshire.
4. Applicable Service Standards
4.1 Applicable National Standards
4.1.1 Standards for Delivery:
All Service Providers will adhere to NICE clinical Guidelines and Quality Standards as well as
the following overarching the following standards: Service Providers should have in place a Standard Operating Procedure specific to the
individual premises;
 Information for providing the Service should be made available for locums, to ensure
continuity of the provided Service;
 Participate in identified local and/or national projects or pilots concerning harm safer
injecting and harm reduction
 Ensure staff delivering the Service are trained and experienced in dealing with
Substance Misuse issues;
 Ensure the maintenance of Staff competencies as per RCGP Part 2 Certificate in the
Management of Drug Use and the needle-exchange competencies;
 Work with Oxfordshire Public Health team to develop and expand specialist roles
subject to agreed negotiation;
 Patients receiving prescribed medication for opioid substitution will not be refused
access to SWOP packs; the pharmacist will encourage the Service User to discuss this
with their prescriber or addictions nurse;
 Provide support and advice to colleagues and other professionals.
4.1.2 Criteria for Operating the Service
 The Service Provider shall have a designated discrete area for consultation which must
meet the following principles:
a. The Service User and the Staff member can sit down together
b. The Service User and Staff member can talk at normal speaking volumes without
being overheard by Staff or customers
c. The area is clearly signed as a private consultation area (a closed room is not
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Identify a lead Staff member working at the Service Provider who has successfully
completed the learning pack Substance use and misuse CPPE 2010 or RCGP Part One
Certificate in the Management of Drug Misuse in Primary Care (or equivalent as approved
by the Council). A Locum will not be expected to have completed the above training
unless they are employed for a period of four consecutive weeks or longer
Staff delivering this contract must conform to the GPhC Standards of Conduct, ethics and
Performance September 2010;
The Service Provider must display the National Needle Exchange Logo, to indicate that
they are operating a needle exchange scheme, subject to availability;
In addition to these criteria the Council recommend that all Staff have Hepatitis B
vaccinations, and will reimburse the costs of these prescriptions and GP administration
fees where required;
These recommendations will be fully implemented through delivery of this Specification.
5. Location of Provider Premises
5.1 This intention of the Council is to select in the region of 35 Service Providers to deliver
the SWOP Scheme in locations across Oxfordshire to ensure a good geographical spread of
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