Appendix A
Waveney Supervised Consumption Specification
1
Introduction
1.1
It is expected that dispensing and supervised consumption will ensure compliance with the
agreed treatment plan by:
 Dispensing prescribed medication in specified instalments.
 Ensuring each supervised dose is correctly administered to the patient for whom it
was intended (doses may be dispensed for the patient to take away to cover the days
the pharmacy is closed).
 Monitoring the patient’s response to prescribed treatment for example if there are
signs of overdose, especially at times when doses are changed.
 If the patient appears intoxicated or when the patient has missed doses, and, if
necessary withholding treatment if this is in the interest of patient safety, liaising with
the prescriber or named Turning Point clinical co-ordinator as appropriate.
 Improving retention in drug treatment.
 Improving drug treatment delivery and successful exit from treatment.
 Reduce the risk to local communities of diversion of prescribed medicines onto the
illicit drugs market.
1.2
This service is for service users of 18 years and above.
2
Service Description
2.1
Supervised Consumption ensures the dose of a drug prescribed has been administered to the
patient at the point of dispensing.
 For methadone it is expected that the patient should be asked to drink some water
and speak after the dose to demonstrate the dose has been swallowed.
 For buprenorphine 3 minutes should be spent supervising the patient as dissolution of
the sublingual tablets may take several minutes, alternatively the tablets may be
crushed in accordance with local protocols.
2.2
Information sharing
 Sharing of relevant information with other healthcare professionals and agencies in
line with locally determined confidentiality agreements and with the patients consent.
2.3
Legal and professional responsibilities
 Ensuring the legality of the prescription and correctness of detail.
 Registering the patient onto the Patient Medication Record.
 Dispensing the medicine in accordance with the prescription system.
 Explaining that missed doses cannot be collected the next day.
 Following local agreed arrangements allowing the dispensing and supervised
consumption of doses not collected on specified days – in accordance with Home
Office guidance on instalment prescribing.
 Pharmacy service providers co-operate with Norfolk & Suffolk Constabularies
Controlled drug liaison officers, the RPSGB Inspection and Public Health, Suffolk
County Council.
 Compliance with current legislation, including the Medicines Act 1968, Misuse of
Drugs Act 1971, Misuse of Drugs Regulations 2001 as amended, Misuse of Drugs
(safe custody) regulations 1973, National Health Services (pharmaceutical services)
regulations 2005.
2.4
Advice including handing out written information as requested and verbal information
 Patients are prepared for the provision of substitute medications by the specialist
drug services and this should be reinforced by pharmacists, this includes advice and
written information about methadone, buprenorphine or other pharmacotherapy,
alcohol use, risk of overdose, loss of tolerance following missed or uncollected doses,
drug interactions, an explanation of supervised consumption and where and how this
will occur, and opening and closing times.
2.5
Screening, risk assessment and referral
 Pharmacists feedback appropriate information to Turning Point and prescribers with
the agreement of the patient, in accordance with their professional code of practise
and local shared care agreements. This includes any concerns around the welfare of
a child.
 Pharmacy service providers make a clinical judgement as to when it may be
appropriate to withhold a dose, e.g. during dose titration if the patient is intoxicated
with drugs and alcohol if there are signs of overdose if the patient has missed one
days prescribed treatment, or if the pharmacist has concerns about the patients
safety.
 Referral to appropriate services.
3
Service Principles
3.1
There is a multidisciplinary approach to prescribing (including GP prescribing)which is carried
out in line with recommendations of Drug misuse and dependence guidelines on clinical
management (DH 2007) and other central guidance and includes the patients pharmacist
 Pharmacists providing supervised consumption services provide a user friendly
service.
 Pharmacists and their staff providing dispensing supervised consumption services for
drug users have standard operating procedures in place for their
individual premises.
 Pharmacists provide service users with information about their medicines.
 The pharmacist ensures that supervised consumption takes place in a private or quiet
area of the pharmacy identified as safe to staff and agreeable to the
patient.
 Pharmacists (or suitably trained qualified or competent members of staff) are required
to supervise (when prescribed or required) the consumption of the prescribed oral
medicine (e.g. methadone or buprenorphine) ensuring the dose has been
administered to the patient.
 Pharmacists abide by local arrangements for clinical governance.
 Pharmacies receive prompt payment for the services provided.
4
Service Description
4.1
Pharmacy service providers enhance engagement with substance misusers in respect to
treatment and motivation for change by paying attention to:
 Good pharmacist and staff interpersonal skills.
 Good pharmacist and staff – service user relations (including feeling they are listened
to, concerns are understood, helpful responses are provided, pharmacist – staff
empathy is shown and there is a good rapport with drug users).
 Working to enhance patients perceptions of the helpfulness of a service.
 Working to improve patients confidence in pharmaceutical care.
4.2
Pharmacists will liaise, within the bounds of their professional code of ethics with
RPSGB medicines, Ethics and Practise confidentiality guidelines with:
 Public Health, Suffolk County Council.
 Specialist Drug Services.
 The Police to collaborate on general issues.
4.3
Specialist services will ensure they are in regular contact with participating pharmacies. They
will ensure staff are supported in their role and will further encourage new pharmacies to join
schemes to ensure coverage across the local area.
4.4
Specialist Substance Misuse Services in partnership with Public Health, Suffolk County
Council will ensure lines of communication are open and effective.
 Provide clear protocols.
 Delineate clear roles and responsibilities of all parties involved in needle exchange to
ensure services are harmonised.
 Ensuring robust clinical governance pathways.
 Ensuring appropriate audit of activity and performance management.
 Arrange at least one contractor meeting per year to promote service development and
update the knowledge of pharmacy staff.
5
Location and Timing of Service
5.1
The service will also need to be provided from premises that are fit for purpose in a modern
and integrated way. This includes the requirement to have a suitable consultation room that
meets the specification for provision of advanced services (MUR) under the Pharmacy
Contract. Services will be required to have some evening, weekend and Bank Holiday
availability as discussed and agreed with commissioners.
6
Integrated Governance
6.1
Any commissioned service must meet all national standards of service quality and clinical
governance including those set out in Standards for Better Health (updated April 2006
www.dh.gov.uk). These core and developmental standards of provision are designed to cover
the full spectrum of health care as defined in the Health and Social Care (Community Health
and Standards) Act 2003. The seven domains are safety, clinical and cost effectiveness,
governance, patient focus, accessible and responsive care, the care environment and public
health. Compliance with NICE guidance www.nice.org.uk is also required.
6.2
Clinical Governance arrangements must be proportionate to the service provided and comply
with any local expectations or requirements of the commissioner.
6.3
Professional competency, education and training
All healthcare professions delivering the service will be required to demonstrate their
professional eligibility, competence, and continuing professional development in order to
remain up-to-date and deliver an effective service. Local courses will be provided by Turning
Point. Staff should be able to demonstrate that they have participated in organisational
mandatory and update training, for example infection control, manual handling, risk
assessment as required.
6.4
Patient, public and staff safety
Providers will be required to demonstrate that Standard Operating Procedures are being
used. Providers should have in place appropriate health and safety and risk management
systems and that premises are safe and young person friendly. They should also ensure that
any risk assessments and significant events are both documented and audited regularly and
outcomes of these implemented. Services should comply with national requirements for
recording, reporting, investigation and implementation of learning from incidents. Further
details can be found on the National Patient Safety Agency website www.npsa.nhs.uk.
6.5
Information management
Any strategy or practice should be coherent with and follow local policies and the Department
of Health Code of Confidentiality, local child protection procedures, and should outline the
mechanisms to safeguard patient information when shared within an integrated service.
6.6
Managing complaints
Responsive protocols and procedures should be in place for managing patient complaints.
Complaints should be reviewed at regular intervals and learning from these shared and
applied as appropriate to ensure that services are continually improved.
6.7
Continuous quality improvement
Providers need to constantly strive for high standards of care and ensure that the quality of
the service is high. Providers will need to demonstrate to the commissioners that they are
providing a high quality service. Examples of audits undertaken, changes to practice and reaudits are good examples of a means of demonstrating that the provider is continuously reappraising and improving the quality of the services being offered.
6.7.1
The provider will:
 Ensure at all times adherence to ‘best practice’
 Ensure that Standard Operating Procedures for the service are reviewed on an
annual basis.
7
Payment Schedule
7.1
Information regarding activity will be collated on the relevant activity forms which also form the
basis of claims. Claims should be submitted to Turning Point, The Victoria, 1 Civic Drive,
Ipswich, IP1 2AR, see attachments. Claim forms must be received by the end of the first full
week of the following month. Claim forms received after the deadline will not be processed.
7.2
Payments for Supervised Consumption will be made monthly.
7.3
Participating providers will be required to keep a record of client contacts and services
provided. The following information will form a minimum dataset:
 Number of individuals seen for supervised consumption.
 The number of observations Methadone.
 The number of observations Buprenorphine.
 Number of visits for needle exchange.
 Amount of equipment distributed.
 Amount of used equipment returned.
7.4
Missed doses – Please advise the prescribing agency when a client has missed a dose.
They may be aware of the reasons and be able to authorise the next instalment of the
prescription, or require the client to make contact with them first. Please use Turning Point
DNA template attached. Any issues report to Turning Point 0300 123 0872.
7.5
If a client has missed three consecutive doses you should not dispense you should
contact the prescribing agency. If a client has a pattern of non-attendance, e.g. always
missing the same day or regularly missing days each week you should also advise the
prescribing agency as their prescription/dispensing arrangements require review. Please use
Turning Point DNA template attached. Any issues report to Turning Point 0300 123 0872.
7.6
Supervised consumption will be paid at the following tariff:
 Methadone £1.30 per observation
 Buprenorphine (Subutex) £1.85 per observation.
 Needle exchange £1.30 per visit/pack issued
8
Service Monitoring and Evaluation
8.1
Service evaluation should cover, as a minimum, the following areas:
Service activity – Volume of work as measured by completed data sheets and other returns.
Clinical Outcomes – will be measured via the review process and by analysis of returned
data.
Quality and Governance – will be assessed at annual review.
Patient Experience – Patients views on their experiences and satisfaction levels will need to
be measured through the Patient Experience Survey.
Value for Money – services will be reviewed against activity levels, outcomes and payments
made to determine ’value for money’. This will link to the quarterly monitoring and annual
review.
Community Pharmacy Claim Form – Methyadone/Subutex Individual Record Sheet
2015-16 Waveney SC Individual claim form.docx
Community Pharmacy Payment Summary Sheet – Supervised Methadone & Buprenorphine
Dispensing
2015-16 Waveney sup con payment summary sheet .docx
DNA reporting template
2015-16 Draft
Waveney - Reporting any client who misses a dose.docx
4 way contract
2015-16 Waveney
-Turning Point- 4 way pharmacy contract.docx