Knowsley Metropolitan Borough Council
Service Level Agreement
for
Community Pharmacist Provision of Needle and Syringe
Exchange Service
1. Parties to the Agreement
This agreement is between:
…………………………………………… (“The Pharmacy”)
AND
Knowsley Metropolitan Borough Council (“The Council”)
2.
Purpose of the Agreement
This agreement relates to the provision of and access to sterile needles and
syringes, within a user friendly, non-judgemental, client centred and confidential
service.
3.
Agreement Period
3.1
3.2
The agreement will commence on 1ST April 14
This agreement terminates on 31st March 16 (see point 6 for information)
4.
Background
In 2006 it was estimated that there was over 129,977 injecting opiate and/or
crack cocaine in England aged 15 to 641 and that 0.1% of people aged 16 to 59
inject performance- and image-enhancing drugs (PIEDs) today1.
Current figures of people on new treatment journeys in Q4 2012/13 are 1391
injecting in England with 9 in Knowsley, compared with 1752 in England and 53
in Knowsley previously2.
People who inject drugs using contaminated equipment (for either the
preparation or injection of their drugs) are at risk of contracting – and
transmitting – blood-borne viruses such as HIV, hepatitis B and hepatitis C.
They are also at risk of a range of other infectious diseases and injection-site
infections1
Although HIV rates remain relatively low among injecting drug users in the UK,
there is concern that rates may be rising. In addition, approximately 40% of
them are infected with hepatitis C. HIV and hepatitis C can be transmitted
1 National Treatment Agency for Substance Misuse, 2005, www.nta.nhs.uk
2 National Treatment Agency for Substance Misuse, 2013, www.nta.nhs.uk
among those who are injecting and, in some cases (via sexual contact,
pregnancy and childbirth) to others who do not inject.
Providing people who inject drugs with clean injecting equipment is cost
effective from a public health perspective.
The Needle Syringe Exchange Programme brings service users into contact
with services which may help by:

emphasising the dangers of overdosing (about 1% of people who inject drugs
die of an overdose each year)

encouraging people to switch from injecting to less harmful forms of drug
taking

encouraging people to opt for opioid substitution therapy

encouraging people to stop using drugs

encouraging people to be tested and treated for hepatitis C and HIV

encouraging people to address their other health needs.
5. Parties to the agreement
Knowsley Council
Pharmacy Contractor-
6. Duration
2 years with an option to extend further by two one year extensions
7. Notice Period
Three months notice is required from Knowsley Council to the pharmacy,
should they not meet the quality standards of the service. This would occur
only if after formal discussions with the contractor the standards had not
improved. To leave the scheme, three months notice is required from the
pharmacy to Knowsley Council.
8. Confidentiality and Data security
8.1 Caldicott
Where for the purposes of delivering the agreed services it is necessary for the
contractor to hold patient identifiable information i.e. that is subject to NHS Rules
on protection and disclosure under the supervision of a named “Caldicott
Guardian” on behalf of the partners, it shall not disclose such information without
the prior consent in writing of the Caldicott Guardian of the organisation from
which the patient identifiable information has originated. It may then disclose
patient identifiable information for proper purposes under procedures supervised
by the Caldicott guardian of the Host organisation.
This consent may be given in general or specific terms, but cannot authorise any
greater degree of disclosure than would be permitted under the Caldicott
arrangements of either party.
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8.2 Data protection.
Data held and processed for the purposes of this contract shall be registered
under the relevant provisions of the Data Protection Act 1998.
8.3 Confidentiality
All parties will endeavour to maintain appropriate confidentiality regarding
information that is proprietary to each of the partners within the context of shared
working.
8.4 Commerciality
All parties shall treat the contents of this contact as “Commercial in confidence” .
9.
Audit Access
Knowsley Council reserves the right to access any paperwork relating to the
service provided, within the appropriate confidentiality boundaries.
10. Financial Arrangements
Input of information onto Webstar will generate monthly invoices for payments
of: £1.70 per unit cost (pack) plus £150 retainer per month.
This covers any additional costs incurred during this contract including
sharps & clinical waste collection and vaccinations.
11 Changes in Service Provision
If the requirements of the service change, and after consultation with the
contractors and agreement with Knowsley Council, the pharmacies will be
notified and asked to support the new initiative.
12 Continuing Professional Development
The service will endeavour to attend, and provide evidence of attendance at
updates provided by the drugs treatment provider, Attendance at a minimum of
one such update per annum will be required.
13 Description of Services and Objectives & Service Schedule
Are detailed in Appendix 1 the Service Specification.
14. Indemnity
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14.1The Provider shall indemnify and keep indemnified the Authority against all
actions, proceedings, costs, claims, demands, liabilities, losses and expenses
whatsoever, whether arising in tort (including negligence) default or breach of
this Contract, to the extent that any such loss or claim is due to the breach of
Contract, negligence, wilful default or fraud of itself or of its employees or of any
of its sub-contractors save to the extent that the same is directly caused by or
directly arises from the negligence, breach of this Contract or applicable law by
the Authority.
14.2 Imitation of liability
Neither Party shall be liable to the other Party (as far as permitted by Law) for
Indirect Losses in connection with this Contract.
14.2.1 Each Party must at all times take all reasonable steps to minimise and
mitigate any Losses for which it is entitled to be indemnified by or bring a claim
against the other Party pursuant to this Contract.
Nothing in this Contract will exclude or limit the liability of either Party
for
a) death or personal injury caused by its negligence; or
b) fraud or fraudulent misrepresentation.
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Appendix 1
NHS Community Pharmacy Contractual Framework
– Needle & Syringe Exchange Service
1.
1.1
1.2
1.3
1.4
1.5
1.6
2.
2.1
2.2
2.3
2.4
2.5
2.6
3.
3.1
Service description
Pharmacies will provide access to sterile needles and syringes, and sharps
containers for return of used equipment. Where agreed locally, associated
materials, for example condoms, citric acid and swabs, to promote safe
injecting practice and reduce transmission of infections by substance
misusers will be provided.
Pharmacies will offer a user-friendly, non-judgmental, client-centred and
confidential service.
Used equipment should be returned by the service user for safe disposal in
sharps bins. The pharmacy is responsible for this, and any costs incurred can
be met through the retainer payment.
The service user will be provided with appropriate health promotion materials.
The pharmacy will provide support and advice to the user, including referral to
other health and social care professionals and specialist drug and alcohol
treatment services where appropriate.
The pharmacy will promote safe practice to the user, including advice on
sexual health and STIs, HIV and Hepatitis C transmission and Hepatitis B
immunisation.
Aims and intended service outcomes
To assist the service users to remain healthy until they are ready and willing
to cease injecting and ultimately achieve a drug-free life with appropriate
support
To protect health and reduce the rate of blood-borne infections and drug
related deaths among service users:
 by reducing the rate of needle and syringe sharing and other high risk
injecting behaviours;
 by providing sterile injecting equipment and other support;
 by promoting safer injecting practices; and
 by 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).
To improve the health of local communities by preventing the spread of bloodborne infections by ensuring the safe disposal of used injecting equipment.
To help service users access treatment by offering referral to specialist drug
and alcohol treatment centres and health and social care professionals where
appropriate.
To aim to maximise the access and retention of all injectors, especially the
highly socially excluded.
To help service users access other health and social care services and to act
as a gateway to other services (e.g. key working, prescribing, hepatitis B
immunisation, hepatitis and HIV screening, primary care services etc).
Service outline
The part of the pharmacy used for provision of the service provides a
sufficient level of privacy and safety and meets other locally agreed criteria.
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3.2
3.3
3.4
3.6
3.7
3.8
3.9
3.10
3.11
3.12
3.13
3.14
3.15
4.
4.1
4.2
4.3
4.4
4.5
4.6
The pharmacy contractor will endeavour 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 pharmacy contractor will endeavour to ensure that pharmacists and staff
involved in the provision of the service are aware of and operate within local
protocols.
The pharmacy contractor should ensure that their staffs are made aware of
the risk associated with the handling of returned used equipment and the
correct procedures used to minimise those risks. A needle stick injury
procedure should be in place.
The pharmacy should maintain appropriate records to ensure effective
ongoing service delivery and audit.
Appropriate protective equipment, including gloves, overalls and materials to
deal with spillages, should be readily available close to the storage site.
The pharmacy is encouraged to display the national scheme logo or a local
logo indicating participation in the service.
Staff involved in the delivery of this service should be offered immunisation for
Hepatitis B which will be provided by their own GP. Any costs incurred can be
met through the retainer payment.
Pharmacists will share relevant information with other health care
professionals and agencies, in line with appropriate confidentiality principals.
The substance misuse provider will arrange one contractor meeting per year
to promote service development and update the knowledge of pharmacy staff.
The CRI will provide the exchange packs and associated materials (see
appendix for flow chart).
The collection and frequency of waste collection should be arranged by the
pharmacy and agreed to ensure there is not an unacceptable build up of
clinical waste on the pharmacy premises.
All relevant information will be inputted onto Webstar to generate a monthly
payment
The council will provide details of relevant referral points which pharmacy
staff can use to signpost service users who require further assistance.
Quality Indicators
The pharmacy has appropriate health promotion material available for the
user group and promotes its uptake.
The pharmacy reviews its standard operating procedures and the referral
pathways for the service on an annual basis.
The pharmacy contractor will endeavour 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 pharmacist will
maintain own competencies through CPPE and ensure records of all trained
staff are held within the pharmacy for audit purposes
The pharmacy can demonstrate that pharmacists and staff involved in the
provision of the service have undertaken CPD relevant to this service.
The pharmacy participates in any Council organised audit of service
provision.
The pharmacy co-operates with any locally agreed assessment of service
user experience.
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Declaration & Agreement Signatories
I confirm that this Pharmacy wishes to provide the Needle and Syringe Exchange
Service from 1st October 2013 to 31st March 2015 as per the above specification.
I declare that the information given on this agreement form is true and complete to
the best of my knowledge. I understand that action may be taken against me if I
make an incorrect claim.
Pharmacy’s
signature………………………………………Date.…………………………….
Pharmacy’s Name (print) …………………………………….
Address of premises
…………………………………………………………………………………………
…………………………………………………………………………………………
Authorised by:
Date:
Who
Signed
Matthew Ashton
Director of Public
Health
Julie Tierney
Public Health
Specialist
For supplies of needle exchange materials please see attached pathway or contact
Lindsey.Lawrence@cri.org.uk
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Background information – not part of the service specification
The National Treatment Agency for Substance Misuse service specification for Needle Exchange
and Harm Reduction sets out a series of objectives for needle exchange services generally, these
apply to services commissioned from community pharmacy and are reflected within the service
specification:















To offer user-friendly, non-judgmental, client-centred and confidential services;
To assist the service users to remain healthy until they are ready and willing to cease
injecting and ultimately achieve a drug-free life with appropriate support;
To reduce the rate of sharing and other high risk injecting behaviours by providing sterile
injecting equipment and other support;
To reduce the rate of blood-borne infections among drug users;
To reduce drug-related deaths (immediate death through overdose and long-term such as
blood borne infections);
To promote safer injecting practices;
To provide focused harm reduction advice and initiatives, including advice on overdose
prevention (e.g. risks of poly-drug use and alcohol use);
To provide and reinforce harm reduction messages;
To help service users access drug treatment to refer to other specialist drug (and alcohol)
treatment services;
To help service users access other health and social care and to act as a gateway to other
services (e.g. key working, prescribing, hepatitis B immunisation, hepatitis and HIV
screening, primary care services etc);
To facilitate access to primary care where relevant;
To ensure the safe disposal of used injecting equipment;
To prevent initiation into injecting and to encourage alternatives to injecting;
To aim to maximise the access and retention of all injectors, especially the highly socially
excluded, through the low-threshold nature of service delivery and interventions provided;
and
To improve the health of local communities by preventing the spread of blood-borne viruses
and by reducing the rate of discarded used injecting equipment.
There is good evidence that community pharmacy based needle exchange services can
complement and support other needle exchange and harm minimisation initiatives commissioned
by drug treatment agencies.
Background information for Drug Action Team (DAT) commissioners:
Service Specification Tier (2 or 3), Pharmaceutical Services for Drug Users, National Treatment
Agency for Substance Misuse, 2005, www.nta.nhs.uk
National scheme logo:
CPPE training which may support this service:
Opiate treatment: Supporting pharmacists for improved patient care open learning
Public Health – drug users, harm reduction workshop
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