1. Agreement
This agreement is made on Monday 18 th August 2008, between Islington Primary Care Trust
(the Commissioner, hereinafter referred to as ‘the IPCT’) and the pharmacy named on page
6 (hereinafter referred to as ‘the Service Provider’) for the period of 6 months.
2. Objectives

To assess whether pharmacies have a role in offering vascular risk assessment to attract new groups of patients that do not routinely approach GMS services.

To assess whether such a pharmacy service could be cost effective and deliver a service to agreed quality standards and protocols.

To increase the awareness of cardiovascular disease and associated risk factors (high cholesterol, high blood glucose, high BMI and high blood pressure) to the local community thereby reducing the number of premature deaths from cardiovascular disease in Islington

To improve the health of the local community through investment in lifestyle factors by preventing or reducing the risk of CVD, particularly smoking cessation, diet modification and blood pressure reduction, and prevention through primary care (principally lifestyle advice and adjustment and medical treatment).

To increase the number of venues offering cardiovascular risk screening

Pharmacists to signpost the availability of other services, thereby increasing numbers of people accessing smoke cessation services, exercise on referral programme and diabetes services

To act as a first port-of-call for information on cardiovascular disease and first line advice including smoke cessation, healthy eating advice and exercise.

To increase partnership working and improved communication between pharmacists and other healthcare professionals;
 To enhance pharmacists’ professional practice;
3. Specification

Accredited pharmacists will undertake structured lifestyle and risk factor assessments with patients/customers, including age, sex, ethnicity, family history (CVD and diabetes), fruit and vegetable consumption, physical activity, BMI and/or waist circumference, smoking, blood pressure and random blood glucose.
 Eligible patients to proceed to ‘further assessment’ if they tick one of the following criteria
– BMI>= 27, Waist circumference >=80cm if F, >=94cm if M, >=90cm if S.Asian mail, current or recent smoker (<5 years), South Asian ethnic origin, Family history of early onset (premature) CVD or diabetes (m<55yrs, f<65yrs), random blood glucose above
5.6-11mmol/L or BP>=140/>=mmHg.

Further assessment will require accredited pharmacists to offer fasting blood glucose and cholesterol testing. A cardiovascular risk score will be calculated using the University of
Edinburgh Framingham Risk Calculator. Depending on score (LOW<=9%, MEDIUM10-
19% and HIGH>=20%), 1st line advice OR 1 st line advice and 12 week reassessment OR
GP referral (respectively) to be actioned.
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SLA for Cardiovascular Risk Assessment Screening Pilot

Approved referral letter must to be used to send to the GP, in addition the approved referral DNA form must used when a high risk client has not returned for further assessment.

The Service Provider must only use the approved equipment provided to them by the
IPCT

The Service Provider will offer a user-friendly, non-judgmental, client-centred and confidential service.

The screening programme will be made free of charge to the client at NHS expense. If the Service Provider is found to be charging patients/customers their contract will immediately be terminated and will be removed from the pilot

The part of the pharmacy used for provision of the service provides a sufficient level of privacy (ideally at the level required for the provision of the Medicines Use Review service 1 ) and safety.

The Service Provider 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, including sensitive, client centred communication skills.

The Service Provider must maintain appropriate records to ensure effective ongoing service delivery and audit. Records will be confidential and should be stored securely and for a length of time in line with local NHS record retention policies.

Pharmacists may need to share relevant information with other health care professionals and agencies, in line with locally determined confidentiality arrangements, including, where appropriate, the need for the permission of the client to share the information.

The accredited pharmacist will record all relevant information onto the CVD data collection template for the purposes of audit and the claiming of payment.

The IPCT will be responsible for the promotion of the service locally, including the development of publicity materials, which pharmacies can use to promote the service to the public.

The Service Provider will be responsible for the provision of DOH leafelts******, smoke cessation leaflets, patient advisory liaison service (PALs) so to effectively deliver 1 st line
 advice when deemed appropriate
4. Quality Indicators

The Service Provider has appropriate and IPCT approved health promotion materials available for the client group, actively promotes its uptake and is able to discuss the contents of the material with the client, where appropriate.

The pharmacy submits the updated CVD data collection EXCEL spreadsheet to the IPCT on the 5 th of every month. Template to be sent to
.
Template to be used for evaluation and monitoring purposes, and in addition for payment monitoring.

The Service Provider co-operates with any locally agreed PCT-led assessment of service user experience.

Pharmacists to attend end of pilot evaluation meeting to review the pathway and service protocol.
5. Payments


The Service Provider will receive one x full locum cover (£225) to attend full day pilot training
The Service Provider will receive £100 for set up costs, to purchase ********
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SLA for Cardiovascular Risk Assessment Screening Pilot
 The Service Provider will receive one payment of £500 for all data entry and sharing required through out course of the 6 month pilot
 The Service Prov ider will receive £5 per completed Health Assessment from (CVD1), minimum target will be 100 forms.
 The Service Provider will receive £35 per part-completed (1 st visit) Cardiovascular Risk
Assessment form (CVD3); minimum target will be 60 forms.
 The Serv ice Provider will receive £20 per completed (2 nd visit – “further assessment”)

Cardiovascular Risk Assessment form (CVD3), minimum target 40 forms.
The Service Provider will receive £20 for each client attending the 12-week re-testing assessment (3 rd visit), minimum target will be 5 clients.
6. Payment Schedule
The Service Provider must submit a finance claim form to Lucy Saunders on below dates to receive payment. Claim forms will be matched with CVD data collection EXCEL spreadsheet.
Month:
5 th December
5 th March
5 th June
Payments will be made to Service Provider as follows
Month:
29 th August
12
13 th th
December
March
Item:
Locum cover (£225)
Set up costs (£100)
Data entry & sharing (£500)
3 rd month mark claim submission
6 th month mark claim submission
12 th June Final claim submission
7. Training

The Service Provider must have successfully completed the pilot training course run by the IPCT.

Only trained Pharmacists will be aloud to deliver the service, ensuring quality standards

8. Premises

The service can only be provided in an approved Service Provider (pilot site), which should have a suitable area for consultation with the patient. This may be a consultation area as defined within the Advanced Services of the Pharmacy Contractual Framework or quiet area agreed within the shop agreed with IPCT where privacy can be maintained.

The pharmacy will be required to provide dedicated window space for a window poster to advertise the availability of the service from that pharmacy.
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SLA for Cardiovascular Risk Assessment Screening Pilot
9. Indemnity

The Service Provider will operate in accordance with all Acts of Parliament, statutory regulations or other such laws, recommendations, guidance or practices as may affect the provision of services specified under the Agreement.

Any litigation resulting from an accident or negligence on behalf of the Provider is the responsibility of the Provider who will meet the costs and any claims for compensation, at no cost to the IPCT. The pharmacist must ensure that their professional indemnity insurance provider has confirmed that this activity will be included in their policy.
10. Patient confidentiality

Medicines, Ethics and Practice - A Guide for Pharmacists . No 28. July 2006; Code of
Ethics and Professional Standards: Part 2: Standards of Professional Performance,
Section C: Confidentiality
“The public expects pharmacists and their staff to respect and protect confidentiality. This duty extends to any information relating to an individual, which pharmacists or their staff acquire in the course of their professional activities. Confidential information includes personal details and medication, both prescribed and not prescribed.”

The General Medical Council (GMC) has also issued a statement about the duty of confidentiality:
“Patients are entitled to expect that the information about themselves or others, which a doctor learns during the course of a medical consultation, investigation or treatment, will remain confidential.

Any explicit request by a patient that information should not be disclosed to particular people, or indeed to any third party, must be respected save in the most exceptional circumstances, for example where the health, safety or welfare of the patient or someone other than the patient would otherwise be at serious risk.”
This duty of confidentiality applies equally to people who are under the age of 16.
11. Clinical support
The accredited pharmacist should not work in isolation and must feel confident to refer to other sources of information and support services such as, other participating pharmacists, and GP Practice, subject to the requirement for confidentiality.
12. Client groups
The target client group is men and women aged 40 years and over and registered with an
Islington GP. Clients that do not fall into the target group should still be offered general 1 st line advice or sign posted to appropriate services, i.e. Patient Advisory Liaison Service.
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SLA for Cardiovascular Risk Assessment Screening Pilot
13. Referral and Follow up
 If a client does not attend for “further assessment” (fasting bloods and cholesterol) you must send the GP referral DNA letter to inform GP of outcome
 Upon a client attending “further assessment” (fasting bloods and cholesterol), and their CVD risk is deemed high risk, you must ask the client to make an appointment with their GP and send the GP the GP referral letter with the clients test results
 Upon a client attending “further assessment” (fasting bloods and cholesterol), their
CVD risk is deemed medium risk they must be asked to come back in 12 weeks for reassessment. If client does not attend, the Service Provider must send a GP referral
DNA letter to the clients GP

Upon a client attending the 12 week reassessment, the CVD risk is deemed low, the
Service Provider must provide 1 st line advice as deemed appropriate.

Upon a client attending the 12 week reassessment, the CVD risk is deemed medium to high risk, the Service Provider must ask client to make an appointment with their
GP and send the GP the GP referral letter with the clients test results
14. Record keeping
Pharmacists must keep a record of the consultation and its outcome on the CVD Data
Collection EXCEL Spreadsheet that has been provided by the IPCT. Client records must be kept by the accredited pharmacy for 8 years.
15. Data returns (CVD Data Collection EXCEL Spreadsheet)
Spreadsheet must be returned to the IPCT by the 5 th of every month, as follows:
Monthly
5 th October
5 th November
5 th December
5 th January
5 th February
5 th March
5 th April
5 th May
5 th June
Pharmacists need to input the record of each consultation onto the CVD Data Collection
EXCEL Spreadsheet provided. The spreadsheet must be emailed to Mahnaz Shaukat,
Information Team, Public Health, Islington PCT, 338-346 Goswell Road, London EC1V 7LQ.
EMAIL: mahnaz.shaukat@islingtonpct.nhs.uk.
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SLA for Cardiovascular Risk Assessment Screening Pilot
LEAD OFFICERS FOR AGREEMENT
The lead commissioning officer for this agreement is:
Name: Helen O’Keefe
Position:
Address:
Public Health Prevention Manager
Islington PCT
338-346 Goswell Road
London
EC1V 7LQ
Telephone: 020 7527 1250
Email: helen.okeefe@islingtonpct.nhs.uk
The Lead Service Provider Officer for this agreement is:
Name: ………………………………………..
Position: ………………………………………..
Pharmacy: ………………………………………..
Address:
Telephone:
………………………………………
Email:
………………………………………
SIGNING OF THE AGREEMENT
This document and the attached notes comprise the Agreement concluded between
Islington PCT and the pharmacy named above.
SIGNED : ……….…………………………
SIGNED : ……….…………………………
Date: …………...….….
Date: …………...….….
Prepared by Helen O’Keefe August 2008