TRAFFORD COUNCIL CONTRACT
For the provision of Trafford Community Pharmacy
Needle Exchange and Supervised Consumption Service
TRAFFORD COUNCIL
AND
xxxxxxx
PERIOD BETWEEN
DATE: 1st April 2013 – 31st March 2014
This Agreement is made between Trafford Council, hereafter referred to as the Purchaser and
xxxxxxxxx hereafter referred to as the Provider.
This Agreement is dated the 31st March 2013.
1.
Parties
This Agreement is made between Trafford Council and xxxxxxx. Failure to sign and return this
Contract will result in non-payment of invoices.
2.
Purpose
2.1
To specify the terms of Agreement between parties to secure provision of the services
specified below and subject to the terms and conditions specified in this Agreement.
2.2
All information contained in this contract should be cascaded to the necessary
personnel in order to raise awareness of the contractual obligations.
2.3
The Purchaser acknowledges that the Provider has only agreed to provide the funding
specified in this Agreement.
2.4
If the Purchaser and the Provider wish as a later date to mutually change the nature of
the project, they can agree to do so in writing.
3.
Project Title
3.1
Community Pharmacy Supervised Consumption and Needle Exchange Service
3.2
Variation
The Purchaser and Provider agree to inform each other of any situation which could materially
affect the terms of this Agreement, including those of funding, statutory requirements, staffing
or service provision. Any action must be agreed by both parties, and reflected by amendment
to this Agreement.
4.
The Accountable person
4.1
On or before the date hereof, the Provider will nominate a person who will act as the
“Accountable Person”. In this instance:
4.2
Throughout the lifetime of this Agreement the Accountable Person must liaise regularly
with the Provider and in any event not less than once quarterly.
5.
Term
5.1
This Agreement shall be in effect from 1st April 2013 to the end of the project in
accordance with this Agreement, March 31st 2014
1
6.
Milestones of the Project
6.1
6.2
Target rate of return for sharps bins for 2013/14 is 60%.
An effective pathway for referral of drug injector to drug treatment to improve the rate of
referrals.
Table to show target achieved in 2012/13 and expected target for 2013/14.
2012/13 2013/14
No of sharps bins given out
No of sharps bins returned
Rate of return
Rate of return expected
7.
60.0%
Management
The Provider shall:
7.1
Ensure that in carrying out the project that the Provider and any person acting on its
behalf complies with all legislation in force at the time; and, without limitation, shall not
commit any act of discrimination (either direct or indirect) rendered unlawful by the Sex
Discrimination Act 1975, and the Race Relations Act 1976, the Disability Discrimination
Act 1995 or any amendments thereof.
7.2
Take all necessary steps to secure the health, safety and welfare of all persons involved
in providing the project.
7.3
The Provider will acknowledge the support of the Purchaser in any publicity relating to
the project.
8.
Review Period
8.1
The review process will normally take place quarterly.
8.2
The milestone for referral will be monitored through the Drug Treatment Services who
will approve a referral from a pharmacist for payment.
8.3
Returned injecting equipment will be monitored through claims for payment and from the
recorded number of pickups by the Waste Management company. The rate of return of
60% will start from 1 month of the start of the contract; i.e. May 2013.
9.
Rights and Obligations on Termination
9.1
On termination of the Agreement (whether by notice or expiry or otherwise) the Provider
shall:
9.2
as soon as reasonably practicable return to the Purchaser any assets or property then in
its possession in connection with this Agreement.
2
9.3
The termination of this Agreement shall not prejudice or affect the right of action which
either party might have against the other.
9.4
Where the Agreement reviews at 3 and 6 months highlight that the Provider is not
performing to the Agreement, then a meeting will be held between the Purchaser and
the Provider. This meeting will devise an agreed action plan to bring the performance
back in line with the Agreement. Where performance cannot be brought back into line, if
Purchaser and Provider agree, an Improvement Action Plan will be drawn up. Where
non-performance has been highlighted and the non-performance process has been
completed, if Purchaser and Provider do not recommend an Action Plan, the contract
may be terminated.
9.5
The service Provider shall notify the Purchaser as quickly as practicable if for any
reason they are unable temporarily to meet its commitments under this Agreement.
9.6
Termination of this contract shall have no effect on the liability of either party to the
payments of any sum arising under this Agreement before the date upon which
termination takes effect.
9.7
Either party may terminate this Agreement at any time by giving Three month’s written
notice. Any notice will state the reasons for termination.
9.8
The Purchaser may terminate the contract forthwith and without notice and recover from
the Provider the amount of any loss resulting from such termination if the service
Provider:
a)
b)
c)
d)
e)
f)
9.9
Commits what in the reasonable opinion of the Purchaser is a serious breach of its
obligations under the Agreement
Commits any other breach of its obligations under this Agreement which can be
remedied, and fails to remedy such breach within the time specified in the written
notice from the Purchaser specifying the breach complained of
Goes into receivership or liquidation, becomes insolvent or is affected by any other
financial and/or organisational circumstances which bring into question the long-term
viability of the Service Provider
Takes serious financial advantage of the relationship with the Service User or their
relative/representative e.g.: taking loans or making business arrangements
Has been convicted of any offence under the Prevention of Corruption Acts 18991916 or the Local Government Act 1972
Gives any undisclosed or illicit fee or reward to any elected member or officer of the
Council in order to acquire unfair gain or advantage
If the Purchaser is in breach of any of the terms of the contract which are material, and
the Service Provider has served notice, giving 31 days for the breach to be remedied,
and the breach is not remedied within such a time period the Service Provider may
without prejudice to any accrued rights or remedies under the Agreement, terminate the
Agreement by notice in writing having immediate effect.
3
9.10
Arbitration
In the unlikely event of disputes, the named contacts to the Agreement will meet to
attempt resolution. In the event of failure to resolve, the matter will be referred to the
Director of Commissioning and Service Development for final resolution. The whole
process should take no longer than 31 days.
10.
Governance Arrangements
10.1
It will be the responsibility of the Provider to ensure that governance arrangements are
in place and that as a minimum:
10.2
The Provider also agrees to compliance with the following acts and to adhere to the
expected standards involved







10.3
The Race Relations Amendment Act (2000)
The Healthy and Safety at Work Act (1974)
Sex Discrimination Act 1975
Disability Discrimination Act 1995
Data Protection Act 1998
Human Rights Act 1998
Misuse of Drugs Act 1971
The Provider should ensure that effective policies are in place to promote the well-being
and safety of staff and service users. This should include the following:











Complaints and grievances procedures
Reporting and monitoring of accidents to staff and service users
Equal Opportunities
Child Protection
Occupational Health
Policies related to confidentiality
HIV/AIDS policies including in recruitment
Management of violence
Fire/Business Continuity
Codes of conduct and rights of service users
Training and development of staff
11.
Insurance
11.1
The Provider shall take out insurance policies sufficient to cover its liabilities under this
Agreement including (without limitation) insurance to cover the following risks:
11.1.1 Public and Employer’s Liability up to £10,000,000
11.1.2 Professional Indemnity
11.1.3 Fire and other risks to premises where training may take place or where the
project operates
11.1.4 Risks arising from use of vehicles
11.1.5 Theft or damage to property and contents of premises where the project operates
4
12.
Indemnity
12.1
The Purchaser accepts no liability to the Provider or to any third party for any costs,
claims, damages or losses however they are incurred
12.2
The Provider shall indemnify the Purchaser for any costs, claims, damages or losses
arising as a result of the negligence or wilful act or omission of the Purchaser its
servants or agents
13.
Force Majeure
13.1
Both parties are exempt from liability in the case of some unforeseen event beyond the
control of that party preventing it from performing, i.e. natural disaster or “Act of God”.
14.
Data protection Act 1988
14.1
Both the Purchaser and the Provider agree they will comply with all the requirements of
the Data protection Act 1998 in relation to this Agreement.
15.
Intellectual Property Rights
15.1
In delivering the project, the Provider shall obtain the approval of any third party before
utilising any material which is or may be subject to Intellect Property Rights owned by
that third party. The Provider shall indemnify the Purchaser against all claims,
proceedings, actions, damages, legal cost expenses and any other liabilities arising
from or incurred by the use of the Provider in performance of the project, or the use by
the others in the project, following delivery by the Provider of any material which
involves infringement or alleged infringement of the intellectual Property Rights of any
third party.
16.
Confidentiality
16.1
Each party
a) shall treat as confidential all information obtained from the other party under or in
connection with the Agreement
b) shall not disclose any of that information to any third party without prior written
consent of the other party, except to such persons and to such extent as may be
necessary for the performance of the Agreement; and
c) shall not use any of that information otherwise than for the purpose of the Agreement
16.2
The Provider shall take all necessary precautions to ensure that all information obtained
from the Purchaser under or in connection with the Agreement:
a) is given to the minimum number of staff and then only to the extent necessary for
each member of staff’s activities in the provision of the Project; and
b) is treated as confidential and not disclosed (without prior approval by the Purchaser)
or used by any staff otherwise than for the purposes of the Agreement
5
17.
Financial Arrangements
17.1
Method of Payment


Payment will be made on submission of the relevant form/s as attached to Schedule
One of this contract – The Specification.
Payment of the grant will be made monthly in arrears on receipt of expenditure,
monitoring information and supporting information as required. Claims should detail
the numbers of clients accessing Needle Exchange and /or the number and initials
of clients receiving Supervised Consumption.
6
Community Pharmacy Supervised Consumption and Needle Exchange Service
Signed on behalf of:
Trafford Council
SIGNATURE
NAME
Mark Grimes
POSITION
Programme Manager
Children, Families & Wellbeing
DATE
31st March 2013
Signed on behalf of
xxxxxxx
SIGNATURE………………………………..
NAME ……………………………………….
POSITION…………………………………..
DATE………………………………………..
7
Schedule One
The Specification
Written by
Debbie Nash
Trafford DAAT Manager
Approved by
Amy Lepiorz
PCT
Review date
February
2012
May 2012
January
2014
8
Contents:
item
Page
1
Executive Summary
10
2
Aims and objectives of the service/s
10
3
Definition – of a needle and syringe programme
12
4
Payment details
15
5
Definition - of supervised consumption service
16
5
Quality Indicators & Performance Management
19
6
Action Plan
20
7
Participating Pharmacies
21
8
Appendix A
Forms and Guidance to Completing Forms
22
9
Executive Summary
This new contract aims to provide clear minimum standards for pharmacies, reward high
quality services and make better use of the skills of pharmacists and their staff. This contract
is an enhanced service to be delivered by appropriate pharmacies. Trafford commissioners
will not pay for the seven essential services that form part of the essential service delivery;
these are:






Dispensing, including support for people with disabilities
Disposal of unwanted medicines
Promotions of healthy life styles (public health)
Signposting
Support for self care
Clinical governance
These essential services should be automatically applied to benefit substance misusers and
should be supplemented by the enhanced needle exchange and/or supervised consumption
services as described below.
This Trafford specification has been developed to improve the quality of the delivery, and
health outcomes for the provision of a needle exchange service and a supervised consumption
service.
Trafford recognise the effectiveness of the role played by pharmacists and would like to
encourage the growth in quality and breadth of the service. Pharmacists, as part of a team of
healthcare professionals, have a key role to play in providing services to substance misusers.
They also act as a link to treatment services and other relevant agencies by acting as referral
agents for clients to attend treatment.
Aims and Objectives of the services
The overall aim of pharmacy services to drug users are to assist the service user to remain
healthy, reduce drug related harm, work towards Recovery, provide service users with regular
contact with a healthcare professional and help them access further advice or assistance.
Pharmacy needle exchanges aim to reduce the rate of sharing and other high risk injecting
behaviours by providing sterile injecting equipment and other support, as well as ensuring the
safe disposal of used injecting equipment. It is essential for providers to encourage the return
of needles.
Pharmacies providing dispensing services for substance misusers will ensure compliance with
the agreed Recovery Plan and aim to improve retention in drug treatment by providing
installment dispensing and ensuring each supervised dose is correctly administered to the
patient for whom it was intended. Pharmacists will contribute to the shared care of the patient
by liaising with the prescriber or named key worker directly involved in the care of the patient.
This should reduce the risk to local communities of diversion of prescribed medicines onto the
illicit drugs market. This service will be available to all individuals who have drug-related
problems, including dependent opioid users as well as those who present with additional
polydrug use or concurrent use of benzodiazepines, pychostimulants and alcohol. Clients
using steroids may buy needles, but are not within the scope of the free needle
exchange policy.
10
Access to pharmacy needle exchange facilities and harm reduction initiatives is voluntary and
open, Referrals will be accepted from a wide variety of sources, with self referral being the
most usual route of access. Whenever possible and where appropriate, pharmacy service
providers should facilitate onward referral to specialist drug treatment services.
Pharmacists or other appropriately trained staff should provide direct input wherever possible
to promote harm reduction, health promotion and Recovery. Pharmacists should encourage
hepatitis B immunization and course completion and hepatitis C assessment if the risk of that
disease is high.
It is appropriate for pharmacy needle exchange and/or supervised consumption services to
provide screening, risk assessment, referral, advice where appropriate and needle exchange
equipment as well as compliance with legal responsibilities in dispensing.



Pharmacy needle exchange facilities and harm reduction initiatives provide an easy, low
threshold, open access and user friendly service.
Supervised consumption must take place in a private or quiet area of the pharmacy.
There will be a requirement to share relevant information with all professionals involved in
the treatment of individuals – this within the bounds of pharmacists professional
confidentiality guidelines.
It is essential that pharmacists have an operating procedure in place specific to their premises.
The contracts with each pharmacist or chemist will be managed by the Specialist
Commissioning Team for the foreseeable future or until legislative changes remove Public
Health from the Local Authority. The main contact for this specification will be:
Nicky Bell – Business Support Officer
The contact details are:
Specialist Commissioning Team
Trafford Council
Children, Families & Wellbeing
1st Floor
Trafford Town Hall
Talbot Road
Stretford
Manchester
M32 0TH
0161-912-5797
Email: Nicola.Bell@trafford.gov.uk
The following pages detail the expectations of this specification, the payment regime and the
data reporting requirements.
11
Needle and syringe services
Definition – of a needle and syringe programme
It s anticipated that these interventions would not take longer than 2 -3 minutes 2 or 3 times per
year, and staff should not put themselves in danger in delivering any aspect of this
specification.
The NTA Models of Care classifies needle exchange as a Tier 2 intervention, and are
developed as part of the overall approach to prevent harm and death.
The supply of needles, syringes and other injecting equipment used to prepare and take illicit
drugs (for example, filters, citric acid, mixing containers) The main aim of the service is to
reduce the transmission of blood borne viruses through injecting drugs, it is also to reduce
other harms caused by injecting drugs. A further aim of this specification is to encourage
clients using the service to attend drug treatment provided in the borough.
The provision of the service is to include:









Access to sterile needles and syringes, and sharps containers for return of used
equipment
Encouraging users to register with a GP
Provide advice on safer injecting –i.e a referral to a health specialist within drug
treatment
Requiring users to return injecting equipment to the service for safe disposal
Advice on avoiding overdose
Information on safe disposal of injecting equipment
Help to stop injecting drugs
Referral to other health and social care services
Provide information about agencies offering further support
It is important that care and interventions offered by a pharmacy needle exchange match the
level of training and expertise of the staff. This contract would expect to see included in the
Needle exchange service a range of interventions that include
Screening, risk assessment and referral
Referral to immunisation clinics or services
The target population
Adults over the age of 18 years who inject drugs are the target population for injecting:
 Opioids
 Stimulants
 Other illicit substances
 Non-prescribed Anabolic Steroids, or other performance or image enhancing
drugs – (needles can be provided but clients should be charged for these
needles)
Special attention may have to be given to clients who are not in touch with drug treatment
services.
12
Aims and objectives







To assist the service user to remain healthy until they are ready 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 promote safer injecting practices, to reduce the risk of BBV infection and risk of
overdose
To help service users access other health and social care and to act as a gateway to
other services
To ensure the safe disposal of used injecting equipment
To maximise the access and retention of all injectors, especially the highly excluded,
through the low threshold nature of service delivery
To prevent initiation into injecting and to encourage alternatives to injecting
On going support and advice
A comprehensive assessment of needle exchange clients is not required, especially if it
constitutes a barrier to service utilisation. As a minimum, this contract requires that all clients
must be:













Informed of drug (and alcohol) treatment services in the borough with clear
information on referral and eligibility criteria
Encouraged to register with a GP
Provided with details of other pharmacies offering needle exchange in the locality
Provided with information about harm reduction and services
Provided with information of overdose risks
Informed about the need for the provision of injecting equipment and the risks of
sharing injecting equipment, unsafe injecting practices
Informed about the risks of unsafe disposal of used injecting equipment
Informed about sites for disposal of used injecting equipment
Informed about the importance of always returning used equipment for safe disposal
Given advice on safer injecting practices – the risks of sharing or borrowing injecting
equipment, filters spoons etc
Given advice on legally available paraphernalia including whether and where this
can be accessed by clients if not available via the pharmacy
Given advice on safe storage and handling of injecting equipment
Given advice and interventions on drug-related harm that do not involve injecting
(e.g harm related to smoking crack)
Handing out equipment
Following training in the safe management of needles and syringes, pharmacists managing the
needle exchange service should:
-
Distribute the appropriate pack of sterile needles and syringes
Safely dispose of injecting equipment, including the supply of personal sharps bins, in
the large bins provided by the waste management contract, SRCL.
Please note, these are separate to the bin used to collect patient returned sharps funded
by the PCT.
13
-
-
Distribute other safe and appropriate harm minimisation injecting paraphernalia –
specifically, swabs, filters, citric acid, ascorbic acid and water for injections ( not more
than 2ml of sterile water)
Be consistent in their effort to maximise the return of used injecting equipment.
If clients fail to return used needles after two further visits, pharmacists may want to
consider a refusal to the client of further injecting equipment, until they return the used
paraphernalia.
Staff
Pharmacists and their staff will adhere to the General Pharmaceutical Councils ‘standards of
conduct, ethics and performance’. In addition the National Pharmacy Association (NPA)
provides members with a resource manual on operating a needle exchange.
Pharmacies should ensure that staff who dispense needles, syringes or packs receive
appropriate training for the level of service they offer.
As a minimum this should include awareness training on the safe handling and disposal of
needles, the correct procedures to minimise any risks (a needle stick policy must be in place),
health promotion advice and how to minimise the harm caused by injecting. Staff must be
aware of and operate within the framework of the pharmacies’ protocols. Appropriate protective
equipment will be provided by the contractor for the staff including gloves and overalls and
materials to deal with spillages. Particular consideration should be given to the safety of
pharmacy staff using completely closed consulting rooms
Training must be updated regularly in response to changes in drug use, risk behaviours, BBVs,
harm minimisation and local or national drug strategies or legislation. This may be through
formal events organised or endorsed by Trafford Council or other accredited agencies, through
newsletters, information packs and a variety of on-line learning hubs about substance misuse
(www.smmgo.org.uk is one such site)
Pharmacy policies and protocols
The standard operating procedure for pharmacy needle exchange must detail requirements
around the following issues:
-
Security of staff, stock and premises
Minimising of risk to staff and members of the public
Dealing with unacceptable behaviour and guidance on – what is unacceptable and ways
of minimising unacceptable behaviour
Seeking to prevent needle stick injuries
Client confidentiality – including what to do when a patient request needle exchange
who is also being prescribed substitute medication
Dealing with needle stick injuries based on contemporary definitions and guidance
Dealing with spillage or contamination by potentially infected blood or body fluids, or
spillages of sharps
Dealing with requests for needle exchange where the pharmacist identifies an increased
risk to an individual – ie at risk of overdose, someone recently released from prison,
intoxicated etc.
14
-
Ensure all staff involved in the service are instructed on procedures to be followed in
order to minimise risk
How client can access Patient Opinion or other ways to make comment on the service
How to refuse a client under 18 the needle exchange and what to do in such
circumstances
Distribution of clean injecting equipment, personal sharps containers, citric acid,
ascorbic acid, etc
Guidance on the maximum number of packs that can be issued – and this is preferably
linked to the number of needles returned
Safe storage, disposal and destruction of used equipment and clinical waste
Advice and health promotion materials relating to harm reduction
Information on other harm reduction, needle exchange and treatment facilities
Advice on access to vaccination against hepatitis A and B, relevant to both staff and
patients
Information on who to contact in the event of drug litter not being collected
Monitoring and Review
Monitoring is an integral part of this contract.
Data is collected in order to monitor the uptake of the service, calculate key
performance indicators and calculate payments to the pharmacists.
Information requested in Appendix A must be provided to the commissioner to ensure
full payment of fees.
Service reviews will be undertaken where and when required to inform commissioning
intentions or to investigate client satisfaction
Payment
Will be monthly and in arrears on production of a certified invoice and the accompanying data.
See appendix A.
15
SUPERVISED CONSUMPTION – definition of the service
This service is recognised as a tier 3 provision as it forms an integral part of the substitute
prescribing treatment and requires a high duty of care for the pharmacist dispensing the
controlled drugs.
Pharmacy dispensing and supervised consumption are therefore for those patients prescribed:





For Opioid dependence (titration, detoxification and reduction) and maintenance
regimes (methadone or buprenorphine)
For withdrawal from opioids with non-opioid medications (e.g lofexidine, subutex)
For stabilization and withdrawal from sedatives, where appropriate (benzodiazepines
and alcohol)
For relapse prevention where appropriate ( naltrexone, disulfiram)
For dependent stimulant use including symptomatic treatment medications
Pharmacists providing services to drug users must:





Be integrated and co-ordinated with the local treatment services
Provide the necessary level of privacy to clients
Provide access to a daily supervised consumption service for prescribed oral medicines
(excluding Sundays and Bank Holidays) which ensures the prescribed dose has been
administered to the right patient
Ensure that relevant information can be shared between the healthcare professionals
about the drug user without compromising the individual’s rights
Provide a range of other harm reduction services and support for the users of the
service including referral to primary care and specialist drug and alcohol services
Aims and objectives of the service
Largely to ensure compliance with the agreed Recovery or Treatment plan by:








Dispensing prescribed medication in specified installments
Ensuring each supervised dose is correctly administered to the patient for whom it was
intended (doses may be dispensed to the patient to take away to cover days when the
pharmacy is closed)
liaising with the prescriber, named keyworker and other directly involved in their care of
the patient (where the patient has given written permission)
monitoring the patient’s response to prescribed medication; for example if there are
signs of overdose, especially at times when doses are changed during titration of doses,
if the patient appears intoxicated or when the patient misses doses and if necessary
withholding treatment if this is in the interest of patient safety, liaising with the prescriber
or named keyworker as appropriate
To offer user friendly non-judgemental confidential and user centred services
To liaise with healthcare professionals and others involved in the care of the patient
having due regard for patient confidentially
To assist the service user to remain healthy, reduce drug related harm until they are
ready to ultimately achieve a drug-free life with appropriate support
To reduce the dangers associated with drug misuse, including the risks of HIV, hepatitis
B and C, other BBVs and the risks if drug related death
16




To provide and reinforce focused harm reduction advice and initiatives, including advice
on drug overdose
To facilitate access to primary care where relevant
To provide a range of information to service users including contact details of other
health professionals
To help service users access other health and social care and to act as a gateway to
other services
Pharmacists must not dispense the prescription if it does not fully comply with legal
requirements. Dispensing and supply can be refused in certain circumstances as detailed
below:



If the pharmacist believes the prescription is not genuine or for the person named on the
prescription form
If the pharmacist believes the prescriber has made a clinical error or that the
prescription is clinically inappropriate
If the patient or anyone with them behaves or threatens to behave violently, or commits
or threatens to commit any criminal offence (in the pharmacy)
Patients may also be excluded as a result of a professional risk assessment – this risk can
include patients who have

Missed collecting their prescribed medicine for specified number of instalments and
where their tolerance to the drug may have reduced

those who appear intoxicated.
or
It is important the patients are informed of acceptable behaviour and what types of behaviour
may result in exclusion. It is good practice to establish this prior to commencing the
programme of dispensing or needle exchange.
The target population
Adults over the age of 18 years who are







Prescribed using FP10MDA (or equivalents)
Patients prescribed methadone mixture 1mg in 1ml or buprenorphine sublingual tablets
Patients prescribed injectable Opioid substitute treatment (diamorphine, methadone)
Patients prescribed by named GPs
Patients prescribed by the local specialist substance misuse service
Patients prescribed of other drugs, for example benzodiazepines, naltrexone or
disulfiram
Patients released directly from prison
Pharmacists will need to clear with the commissioner or Drug Specialist team if they are
dispensing to patients outside of the target population.
17
Opening Times
Pharmacists should state clearly which times their services are available to the target
population and this information must be updated and given to patients when there is any
variation to those times. Because confidentiality should be maintained it is useful to avoid
times when patients may not attend because they are apprehensive about recognition as drug
users from other patients.
Basic assessment and ongoing harm reduction
Pharmacists or their staff should provide direct input wherever possible to promote harm
reduction including:




Recognising people with physical health problems or severe mental health problems
and referring them to appropriate services
Carrying out risk assessments and identification of immediate risks (ie injection injuries,
abscesses, harm to others or physical and mental health emergencies) and provide
advice, treatment and referral as appropriate
Actively encouraging service users to access hepatitis B immunisation and to complete
the course
Emphasising the risk of over dose and strategies to reduce overdose
Harm reduction work should be provided in a form that is appropriate and meets the needs and
desires of the service user.
Pharmacy operating procedure
The standard operating procedure for pharmacy supervised consumption must detail
requirements around the following issues:
-
-
Security of staff, stock and premises
Minimising of risk to staff and members of the public
Storage and dispensing of medications in accordance with current legislation
The provision of supervised self administration procedures that are discreet and efficient
to ensure dignity of client
Dealing with unacceptable behaviour and guidance on – what is unacceptable and ways
of minimising unacceptable behaviour
Strategies and procedures for ensuring the dose has been fully consumed
 In case of methadone oral mixture – drink water before hand and speak
after swallowing the dose
 For buprenorphine a longer time will be needed to allow dissolution of the
tablets. Patients should be offered a water before taking their dose
 What procedure to follow if the pharmacist suspects the patient is avoiding
supervised consumption by palming tablets or not swallowing methadone
but keeping it in the mouth
Safe storage, disposal and destruction of clinical waste (in line with Environment agency
requirements) for containers etc used for administering supervised doses
Safe storage disposal and destruction of items which may identify patients e.g. labelled
containers which are discarded after SC
Guidance on what to do if a patient is at risk – i.e. at risk of overdose, someone recently
released from prison, intoxicated etc
Guidance on the policy if the patient requests another person collects their prescription
18
-
Client confidentiality – including what to do when a patient requests needle exchange
who is also being prescribed substitute medication
Advice and health promotion materials relating to harm reduction
Ensure all staff involved in the service are instructed on procedures to be followed in
order to minimise risk
How client can access Patient Opinion or other ways to make comment on the service
Advice on access to vaccination against hepatitis A and B, relevant to both staff and
patients
Information on who to contact in the event of drug litter not being collected
Guidance on what the pharmacist should do when a prescription or patient does not
meet the agreed target population criteria
Guidance on what to do when an expected patient does not appear
Quality Indicators and performance management
1. Pharmacists must demonstrate that they have undertaken appropriate training to deliver
either or injecting equipment or supervised consumption
2. Pharmacists will demonstrate that they have standard operating procedures and that
these are reviewed annually for the injecting equipment or supervised consumptions
services
3. Pharmacists will demonstrate annually that they have undertaken training or refreshed
their skills in the delivery of the injecting equipment or supervised consumptions
services
4. Numbers of needles/packs returned
5. Numbers of client using the service/s
6. Number of clients referred to and accepting treatment services
7. Numbers of people accepting additional health information
Remuneration for level one Needle Exchange Service:
£1
£30
£10
per client pickup
for client accessing Drug Treatment service, if previously not engaged
for client accessing treatment who had previously engaged but out of treatment for more
than 6 months
Remuneration for level one Supervised Consumption Service:
£2
£30
£10
per supervision regardless of prescription
for client accessing Drug Treatment service for the first time
for client accessing treatment who had previously engaged but out of treatment for more
than 6 months
Invoices should be completed as per the form overleaf and sent one month in arrears.
19
Action Plan
Service
Ensure supply of injecting
equipment
Action required
Set up contracts with appropriate
provider
By whom
Trafford Council
Commissioning team
partners
By when
Complete
Needle exchange
Review number and locations of all
sites
Trafford Council
Commissioning team
Trafford PCT
Ongoing
Needle exchange
Review specifications and
remuneration
Trafford Council
Commissioning team
Trafford PCT
Ongoing
Needle Exchange
Sign up contracts with appropriate
pharmacies (ie where there is an
identified need for the service)
Trafford Council
Commissioning team
CWP NHS Trust
Complete
Needle Exchange
Ensure appropriate needles are
allocated to adult clients only
Pharmacies
CWP Intensive Treatment
Needle Exchange
Ensure return of used/unused
needles – possibly by offering a swap
old for new
Pharmacies
CWP NHS Trust and Phoenix
Futures
Ongoing,
needs to be
improved.
Needs urgent
improvement
Needle Exchange
Review numbers of steroid injectors
Consider charging for steroid users
Pharmacies
Supervised Consumption
Increase number of participating
pharmacies
Supervised Consumption
Co-ordinator
monthly
Trafford PCT
Trafford LPC
Complete
Review remuneration
20
Trafford pharmacies currently offering services.
Name of pharmacy
Location
Boots – George Street
Boots
Broomwood
Altrincham
Broadheath
Timperley
The Co-operative
Helgasons
Rowlands (Coppice Ave)
Hollowood
Sainsburys
Rowlands (Norris Rd)
Tesco
Cohens (prev Assura)
Lloyds (Delamere Ave)
Boots
Lostock
C&T Pharmacy
Gorse Hill Pharmacy
The Co-operative
Rowlands
G P Roberts
The Co-operative
Timperley
Altrincham
Sale
Sale
Sale
Sale Moor
Sale
Sale
Stretford
Stretford
Stretford
Stretford
Stretford
Old Trafford
Old Trafford
Old Trafford
Whalley
Range
Urmston
Urmston
Davyhulme
Partington
The Co-operative
Malcolms Pharmacy
Lloyds
Mary Davey Chemist
Needle
Exchange



√








√
Supervised
Consumption

√

√
√
√
√


√




√

√
√
√


√
√
consultation
room in
pharmacy

√







√



21
APPENDIX A
1.
Injecting Equipment Claim Form
2.
Monthly Statistical Report – for Injecting Equipment
3.
Supervised Consumption Claim Form
4.
Injecting Equipment Record Sheet
5.
Supervised Consumption Record Sheet
6.
Steriod Injecting Equipment Record Sheet
7.
Sharps Bins Returned Record Sheet
8.
Supervised Consumptions and Needle Exchange
Guidance Flow Chart
9.
Guidance to filling in Forms for Trafford Needle
Exchange and Supervised Consumption
10. Pack Information – Trafford Pharmacy Based Needle
Exchange – Orion Medical Products
22