Public Health Enhanced Service for
Community Pharmacy Sexual Health Advanced Services
2014/2015
Comprises:
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Sexual Health advice and signposting
Emergency Hormonal Contraception
Chlamydia Screening and Treatment
‘C-Card’ Condom Distribution
Aims
To increase access to community services which offer free advice, treatment and
contraception to reduce the number of unplanned pregnancies in Gloucestershire particularly
in those aged under 18 years, and reduce the prevalence of Chlamydia.
Evidence base
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Standards for the management of sexually transmitted infections (STIs) Medical
Foundation for AIDS & Sexual Health (MedFASH, 2014) recommend that services
providing emergency contraception include the opportunity of Chlamydia testing and
treatment.
Framework for Sexual Health Improvement in England (DoH 2013).
High Quality Care for all: NHS Next Stage Review final report (Our NHS, Our Future
(2008))
NICE guidance on Long Acting Reversible Contraception (LARC), 2005
Gloucestershire Sexual Health Strategy 2012-2017
Service Standards for Reproductive Health (Faculty of Sexual and Reproductive
Health 2012)
Gloucestershire’s Sexual Health Needs Assessment (NHS Glos, 2009)
General overview
Community pharmacies provide a key element of a comprehensive sexual health service in
Gloucestershire. Figure 1 represents the hub and spoke model of level 1-3 sexual health
services. (Note: Community Pharmacies offer a ‘level 1’ community service under this
definition)
Figure 1: Integrated hub and spoke model of sexual health
Specification A: Adv Services
1 out of 8
Service objectives
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To provide professional sexual health care advice; sympathetic understanding to the
client; signposting to appropriate services, with a non-judgmental attitude; addressing
patient choice in a non-clinical setting.
To improve young people’s access to the provision of emergency hormonal
contraception, particularly to women under 25 years, through community pharmacy.
To raise the awareness of the Copper Intra Uterine Device (IUD) as an alternative or
additional method of emergency contraception for increased efficiency.
To increase access to free screening for Chlamydia and to provide free treatment for
young people aged between 15 – 24 years and their partners.
To improve young people’s access to condoms to enable them to protect themselves
against sexually transmitted infections.
To increase uptake of reliable contraception, especially those with multiple use of
EHC and those from ‘at risk’ groups, by referring into mainstream contraceptive
services and explaining the benefits of long acting contraception.
To strengthen the local network of contraceptive and sexual health services to help
ensure easy and swift access to advice.
Expected Outcomes
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To reduce the number of under 18 conceptions in Gloucestershire.
To increase the proportion of terminations performed up to 9 weeks gestation.
To reduce the prevalence of Chlamydia in those aged 15-24 years.
To increase the uptake of Long Acting Reversible Contraception (LARC) methods.
Specification A: Adv Services
2 out of 8
Service Description
Service model and approach
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Pharmacies will offer a user-friendly, non-judgmental, client-centred and confidential
service which links into existing networks for community contraceptive services, for
rapid referral.
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Pharmacies will promote the service including their own websites and using posters
and window stickers as relevant (particularly window stickers for EHC, Chlamydia and
C-Card as provided by Public Health Gloucestershire).
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Provision of EHC, Chlamydia testing and treatment, condom distribution, information
and advice should be offered as an integrated service where appropriate, or
individually as required.
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Under 16 competency is assessed under Fraser Guidelines and recorded.
Emergency Hormonal Contraception
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Supply free EHC (Levonorgestrel or Ulipristal Acetate via PGD to women aged 14-24
yrs resident in Gloucestershire.
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Supply of the anti emetic, Domperidone under PGD if indicated.
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Perform a pregnancy test for women who may be pregnant identified through the EHC
consultation.
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The Copper Intra Uterine Device is discussed as an alternative or additional method
of emergency contraception for increased efficiency and signpost the patient
accordingly.
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Fax referral into the Pregnancy Advisory Service (PAS) or Teenage Pregnancy
Midwives.
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The benefits of Long Acting Contraception will be mentioned during consultation along
with information on where to obtain one.
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Clients aged over 25 who seek a free EHC service may be supplied with EHC free of
charge within the application of the PGD at the discretion of the pharmacist in the
following instances – those who are unable to access a free EHC service within the
critical time scale, or who cannot afford to purchase the OTC product, and for whom
failure to treat could result in an unwanted pregnancy.
Chlamydia screening
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Offer and supply a free Chlamydia test to all attending the service and partner/s. and
opportunistically over the counter.
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The pharmacist will supply Chlamydia treatment (Azithromycin) and advice to all 15 –
24 year old positive clients and their partners (who can be any age) in accordance
with the appropriate PGD.
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Instigate partner notification via Partner Notification letters or CSO pathway.
Condom distribution
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Supply free condoms as a result of sexual health consultation, or to those registered
on the C-Card scheme.
Sexual health advice and information
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The pharmacy will provide support and advice to the patient, including referral to
primary care or specialist centres where appropriate.
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Leaflets are supplied to reinforce health advice given during the consultation e.g.
STIs, HIV, contraception, as directed within PGD.
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Clients excluded from the service criteria will be invited to purchase the Pharmacy
medicine product if appropriate.
Specification A: Adv Services
3 out of 8
Referral, Access and Acceptance criteria
 This service is offered free to the registered population of 14-24 year olds in
Gloucestershire.
 This service is accessed via self-referral to the community pharmacy.
 The pharmacy will provide support and advice to the patient, including referral to
primary care or specialist centres where appropriate.
 Clients excluded from the PGD criteria will be referred to another local service as
soon as possible.
 For continuity of service, long term locums working in these pharmacies are expected
to comply with all aspects of the service – unless exempt.
 When the service is not available (in case of sickness, holiday, or use of short term
locums) the pharmacy staff will signpost client to the nearest service provider. NB: to
avoid ‘losing’ a vulnerable client, a phone call to the next provider may be necessary.
Interdependencies and Whole System Relationships
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The Pharmacy will purchase its own stock of Azithromycin tablets/caps, EHC:
Ulipristal Acetate, levonorgestrel, domperidone and pregnancy tests. These will be
reimbursed as shown in financial detail.
The pharmacy has appropriate health promotion resources available for the service
users and promotes its uptake. These are obtained from Gloucestershire Health
Promotion Resources at http://www.gloshp-resources.nhs.uk/
Public Health will provide access to details of relevant referral points which pharmacy
staff can use to signpost service users who require further assistance. The
information will include the location, hours of opening and services provided by each
service provider.
Public Health will supply health promotion material relevant to the service users, these
will be available as above.
Public Health will provide the framework for the recording of relevant service
information for the purposes of audit and the claiming of payment.
Public Health (via the Prospects C-Card coordinator) will be responsible for supplies
of condoms for use in this service.
Public Health (via Gloucestershire Care Services NHS Trust) will provide Chlamydia
screening kits for use in the service.
Training
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The pharmacy contractor has a duty to ensure that pharmacists and staff involved in
the provision of the service have relevant knowledge, are appropriately trained in the
operation of the service, and are aware of and operate a confidentiality policy which
takes into consideration the needs and rights of under 16s.
The pharmacy should maintain appropriate records to ensure effective ongoing
service delivery and audit, as defined by the service.
Provision of EHC under PGD through accredited pharmacists who have successfully
completed the NHS England core training event and been passed as competent, as
assessed by Contraception and Sexual Health Instructing doctor/s and/or nurse/s.
Provision of Azithromycin under PGD through accredited pharmacists who have
successfully completed the CSO training event.
Provision of C-Card service through suitably trained pharmacy staff provided by the
C-Card Scheme co-ordinator.
Specification A: Adv Services
4 out of 8
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Appropriate training must be given to pharmacy support staff involved in delivery of
the scheme, and must include values/attitudes, confidentiality, language, signposting,
and child protection.
Pharmacists participating in the scheme will be expected to have successfully
completed the following CPPE course/study pack:
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Emergency Hormonal Contraception Open Learning Pack
Sexual Health: testing and treating Open Learning Pack
Contraception Open Learning Pack
Child Protection: a guide for the pharmacy team Open Learning Pack
(or Trust level 1 Child Protection).
CPPE and EHC certificates or equivalent must be provided to Pharmacy Contracts
Manager NHS England, on request.
EHC trained pharmacists must be re-accredited every 3 years through NHS England
open learning update module.
Public Health (via Gloucestershire Care Services NHS Trust) will provide EHC and
Chlamydia training events approximately every 4 months, to train locums and new
staff pharmacists.
Public Health (via Gloucestershire Care Services NHS Trust) will arrange at least one
contractor meeting per year to promote service development and update the
knowledge of pharmacy staff.
Data Requirement (Record Keeping)
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The pharmacy should maintain appropriate records to ensure effective ongoing
service delivery and audit.
The pharmacy will maintain a completed EHC pro forma for each intervention and
relevant supply. And will make a record on the EHC pro forma for each pregnancy
test performed. [this service makes allowance for the movement to Pharma Outputs
for recording of activity as and when this is agreed between Public Health and the
Local Pharmaceutical Committee]
For each EHC intervention the pharmacy should record postcode (first part only –
therefore not identifiable), date of birth, how they heard of the service and return
quarterly to Public Health.
The pharmacy will maintain records as specified by the Azithromycin PGD and CS pro
forma.
The pharmacy will send treatment management forms to the Chlamydia Screening
Office promptly following completed treatments.
The pharmacy will provide monthly data to Public Health of EHC supplied, Chlamydia
screens offered/ accepted and treatments given.
The pharmacy will record C-Card distribution data and provide to the C-Card
coordinator (either paper or online) as specified.
Records are maintained by the pharmacist of interventions and advice given during
consultations. These should be kept for 8 years for adults or in case of under 16s, up
to age 25.
Pharmacists will share relevant information with other health care professionals and
agencies, in line with locally determined confidentiality arrangements.
Data quality will be examined through audit and monitoring of returns.
Quality and Performance Standards
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The pharmacy will have an agreement with NHS England to provide this service.
Specification A: Adv Services
5 out of 8
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The pharmacy will have a suitable consultation area as defined in the drug tariff for
Advanced / Enhanced Services, and agreed by NHS England.
The pharmacist will conduct a confidential consultation with the client; take and record
the client history in an agreed format; discuss the implications fully with the client; and
agree outcomes.
The pharmacy reviews its standard operating procedures and the referral pathways
for the service on an annual basis.
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 a routine NHS England organised audit of service
provision
The pharmacy co-operates with any locally agreed Public Health or NHS England led
assessment of service user experience.
100% women accessing EHC will be offered a Chlamydia test.
70% women offered a Chlamydia test will accept it.
50% women accepting a test will return it to the lab for processing.
Financial Details
Activity for each quarter must be recorded on PharmOutcomes before the end of the
following month so that payments can be made in the middle of the next month. No back
claims subsequent to this will be paid.
Start up fee (per pharmacy) for Level 2 services
(If already providing or previously provided EHC/
Chlamydia screening this will not be a re-start)
Annual retention fee for the community pharmacy
(includes review of SOPs, staff update, training session)
£500
Supply of Ulipristal Acetate is reimbursed at Chemist &
ruggist cost price plus VAT
Supply of levonorgestrel is reimbursed at Chemist &
Druggist cost price plus VAT
Supply of domperidone is reimbursed plus VAT
DT price & VAT
Provision of EHC service paid per intervention working
under PGD, and 100% offer of Chlamydia screen
Reward payment when 40% of EHC clients return a
Chlamydia screen (annually).
Supply of pregnancy test is reimbursed
£10.25*
Chlamydia treatment consultation fee (inc VAT)
Azithromycin reimbursement at drug tariff price plus VAT
Fee for each completed Chlamydia test received by
laboratory
Supply of C-Card condoms per issue
£15 per treatment
DT price + Vat
£5 per return test
£175
DT price & VAT
DT price & VAT
£1.75* per client
C&D price & VAT
£1.75
* Where 40% of EHC clients are screened for Chlamydia the consultation will effectively be
reimbursed at £12 at year end, and Chlamydia screen at £5.
Contractors will be paid the Start Up and Annual Retention fee at the end of quarter 1 whilst
those signing up to the scheme part way through the year will receive a pro rata payment of
the annual retention fee as follows: Specification A: Adv Services
6 out of 8
Sign up in quarter 1 – 100%
Sign up in quarter 2 – 75%
Sign up in quarter 3 – 50%
Sign up in quarter 4 – 25%
Start up fee will only be made for pharmacies who have not previously offered this service.
Payment for Chlamydia screens returned will be paid monthly in arrears by Public Health,
based on the lab screening data.
Contract Period
This is a one year Local Enhanced Service which will run from 1st April 2014 to
31st March 2015. Public Health will review the SLA during the first 6 months and notify
pharmacies accordingly.
Should either party wish to cease providing/commissioning this service they will give three
months notice in writing. Notice in year will result in appropriate return of annual fees.
Queries regarding this service should be made to:
Karen Pitney
Public Health Outcome Manager
Gloucestershire County Council
Shire Hall
Westgate Street
Gloucester
GL1 2TG
United Kingdom
Office: 01452328611
E-mail: karen.pitney@gloucestershire.gov.uk
Specification A: Adv Services
7 out of 8