SERVICE SPECIFICATION FOR THE PROVISION OF CHLAMYDIA TREATMENT IN DORSET

From April 2015 APPENDIX 2.1 SERVICE SPECIFICATION FOR THE PROVISION OF CHLAMYDIA TREATMENT IN DORSET Dorset County Council Dorset Procurement, Leve...
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From April 2015 APPENDIX 2.1

SERVICE SPECIFICATION FOR THE PROVISION OF CHLAMYDIA TREATMENT IN DORSET

Dorset County Council Dorset Procurement, Level 3, North East Wing, County Hall, Colliton Park, Dorchester, Dorset, DT1 1XJ

DORSET COUNTY COUNCIL Public Health 1.

Page 2 of 10

INTRODUCTION

1.1.

This specification sets the requirements for the provision of the service for Chlamydia Treatment within a Community Pharmacy setting.

1.2.

Chlamydia treatment within community pharmacies complements the provision of Emergency Hormonal Contraception (EHC), by offering a more holistic sexual health care service to this user group. Participation by Community Pharmacies in this service is currently voluntary and guided by localised need.

2.

BACKGROUND

2.1.

Genital Chlamydia Trachomatis infection is the sexually transmitted infection most frequently diagnosed in genitourinary medicine (GUM) clinics in England. Prevalence of infection is highest in sexually active young men and women, especially those aged less than 25 years. Untreated infection can have serious long-term consequences, particularly for women, in whom it can lead to pelvic inflammatory disease (PID), ectopic pregnancy and tubal factor infertility. Since many infections are asymptomatic, a large proportion of cases remain undiagnosed, although infection can be diagnosed easily and effectively treated.

2.2.

Chlamydia screening is currently carried out across England as part of the National Chlamydia Screening Programme (NCSP). The objective of the programme is to control Chlamydia through the early detection and treatment of asymptomatic infection, preventing the development of sequelea and reducing onward transmission of the disease. The aim is a multi-faceted, evidence based and cost effective national prevention programme in which all sexually active young men and women under 25 years of age and those under 16 years of age deemed Fraser competent are aware of Chlamydia, its effects, and have access to services providing screening, prevention and treatment to reduce their risk of infection, the development of untoward sequelea and onward transmission. An opportunistic approach is used bringing on board a diverse combination of healthcare and non-healthcare screening venues to deliver the programme. The voluntary and business sectors also play a key role in delivering the NCSP.

2.3.

The NCSP covers the whole country and is managed by Public Health England. National standards apply to the programme and funding has been provided to commission the service.

3.

AIMS AND OBJECTIVES OF THE SERVICE / SERVICE OUTCOMES

3.1.

To increase access to treatment of asymptomatic individuals with chlamydia infection.

3.2.

To increase access for young people to sexual health advice and referral on to specialist services where required.

3.3.

To strengthen the network of contraceptive and sexual health (CASH) services to help provide easy and swift access to advice.

Dorset County Council Dorset Procurement, Level 3, North East Wing, County Hall, Colliton Park, Dorchester, Dorset, DT1 1XJ

DORSET COUNTY COUNCIL Public Health 4.

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DESCRIPTION OF SERVICE

The Provider shall: 4.1

Provide the Service as part of part of the wider locally run service and is intended only for people who are resident in Dorset. However, should the Service, on occasion, be requested by a resident of Bournemouth or Poole, the Pharmacy shall make provision for these service users under this specification.

4.2

Supply azithromycin tablets (or the relevant and appropriate drug recommended by medicine management guidance) to service users under the age of 25 and supply of a Chlamydia test kit (with advice in its use) as a follow up to treatment and epidemiological treatment to their sexual contacts.

4.3

Note that all management of results and tracing of contacts relating to this service shall be undertaken by the locally commissioned sexual health service provider.

4.4

Give advice on the potential side effects and drug interactions with azithromycin.

4.5

Offer a user-friendly, non-judgmental, service user-centred and confidential service.

4.6

Provide support and advice to service users accessing the service, including advice on safe sex, condom use and advice on the use of regular contraceptive methods, when required.

4.7

Undertake appropriate consideration in regard to whether young people under the age of 16 are Fraser competent. Pharmacists and their staff shall be mindful of the young people accessing treatment and where appropriate assess the service user according to Fraser competence criteria.

Care Pathway 4.8 Follow the care pathway as shown in Appendix B

4.9

Service Users who Test Positive for Chlamydia (Index Patient) When a service user tests positive for Chlamydia, the locally commissioned sexual health service provider will contact the service user and offer options for treatment e.g. CASH, GUM, GP or Pharmacy.

4.10 Where the service user chooses to receive treatment in community pharmacy, the locally commissioned sexual health service provider will contact the Provider to arrange for the Service User to attend for treatment. Once it has been established that a suitably trained pharmacist is present, the locally commissioned sexual health service provider will fax the Communication Form (Appendix A) to the Provider to confirm the service user details. No azithromycin can be supplied to the service user without the authorisation of this form. 4.11 The Provider shall see the service user in the Pharmacy at the agreed time. The Pharmacist shall use the PGD and checklist to ensure that it is appropriate to supply the treatment. If the service user cannot be treated under the PGD, the Pharmacist shall make an urgent referral back to the locally commissioned sexual health service provider as per the care pathway in Appendix B and contact numbers in the Appendix C Useful Contacts 4.12 The Pharmacist shall supply Azithromycin as 4 x 250mg tablets. Dorset County Council Dorset Procurement, Level 3, North East Wing, County Hall, Colliton Park, Dorchester, Dorset, DT1 1XJ

DORSET COUNTY COUNCIL Public Health

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4.13 Consumption of the azithromycin must be supervised by the Pharmacist at the time of the treatment consultation. 4.14

The Provider shall supply all service users who receive treatment with one pack of condoms (standard 3 pack of condoms) from Pharmacy stock.

4.15 On completion of the consultation, the Provider shall complete Section B of the Communication Form (Appendix A) and fax this back to the locally commissioned sexual health service provider to verify that the treatment has been supplied and taken by the service user. Treatment of Contacts of Service Users Who Have Tested Positive for Chlamydia 4.16 When a service user tests positive for Chlamydia, the locally commissioned sexual health provider shall undertake the contact tracing process and offer options for treatment to sexual contacts of the service user as appropriate 4.17 Where requested, the Provider shall provide a Chlamydia screening test kit to sexual contacts. (Treatment may be provided to sexual contacts as per this Service Specification i.e. once they have received their test results and been contacted by the locally commissioned sexual health provider.) 4.18 Where the service user opts to receive treatment from the Pharmacy, the locally commissioned sexual health provider will contact the Pharmacy to arrange for them to attend for Chlamydia screening and treatment. The Pharmacy shall wait to receive the Communication Form by fax from the locally commissioned sexual health provider to confirm the contacts service user details and authorise treatment. No azithromycin shall be supplied to the service user by the Pharmacy without this form. 4.19 The Provider shall provide the contact service user with a postal Chlamydia screening test. The contract service user must undertake the test and return it to the Pharmacy prior to the Pharmacy being able to supply azithromycin. It is not necessary for the pharmacy to wait for the result of the test for contact service users prior to supplying azithromycin and this shall therefore be undertaken immediately after the contact service user has undertaken the Chlamydia test. 4.20 Once the Chlamydia screening test has been completed, the Pharmacist shall use the PGD and checklist to ensure that it is appropriate to supply the treatment. If the contact cannot be treated under the PGD, they will be urgently referred back to the locally commissioned sexual health service provider. 4.21 Consumption of the azithromycin must be supervised at the time of the treatment consultation. 4.22 The Provider shall supply all service users who receive treatment for Chlamydia with one pack of condoms (standard 3 pack of condoms) from Pharmacy stock. 4.23 The Provider shall offer treatment to all contacts, even if they are over the age of 25. 4.24 On completion of the consultation, the Provider shall complete section B of the Communication Form (Appendix A) and fax this back to the locally commissioned sexual health service provider to verify that the treatment has been supplied and taken by the service user.

Dorset County Council Dorset Procurement, Level 3, North East Wing, County Hall, Colliton Park, Dorchester, Dorset, DT1 1XJ

DORSET COUNTY COUNCIL Public Health

Page 5 of 10

4.25 The Provider shall ensure that an adequate supply of Chlamydia test kits are available for sexual contacts. Additional test kits can be ordered by contacting Sam Richards, Public Health Dorset, on 01202 261107 or by emailing [email protected] Training 4.26 The Provider shall ensure that all pharmacists providing the Service have signed and are operating as required by the up to date PGD. 4.27 Before offering the service, all Pharmacists providing treatment under the PGD must successfully complete the CPPE Safeguarding Children and Vulnerable Adults 2012 elearning module (1.5hrs). 5

QUALITY STANDARDS The Provider shall:

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5.1

Stock and maintain appropriate health promotion material available for the Service User group and promote its uptake and is able to discuss the contents of the material with the Service User, where appropriate.

5.2

Have in place a standard operating procedure for the delivery of this service and shall review its standard operating procedures and the referral pathways for the service every 2 years or sooner if there are changes to the service.

5.3

Participate in any Dorset County Council organised audit of service provision.

5.4

Co-operate with any locally agreed assessment of service user experience.

5.5

Demonstrate that Pharmacists and staff involved in the provision of the service have undertaken CPD relevant to this service.

5.6

Acknowledge that the service is funded by Public Health Dorset, Dorset County Council.

5.7

Fully comply with the Pan-Dorset’s Multi agency Safeguarding Adults Policy and the Pan Dorset LSCB Inter-Agency Procedures for Children and Young People

5.8

Ensure that thorough recruitment and selection processes are in place which includes full tracking of previous employment history, checking of qualifications and two written references

CONTRACT MONITORING Community Pharmacy Contractual Framework 6.1 The Provider must remain compliant with all the essential services under the Community Pharmacy Contractual Framework as part of this Agreement. 6.2

No part of this Specification by commission, omission or implication defines or redefines essential or advanced services.

Monitoring and Review 6.3 The Provider shall ensure that the necessary documentation, as detailed in this service specification, is maintained and made available to the commissioner to enable the service to be monitored and for the purpose of post payment. Dorset County Council Dorset Procurement, Level 3, North East Wing, County Hall, Colliton Park, Dorchester, Dorset, DT1 1XJ

DORSET COUNTY COUNCIL Public Health

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6.4

The Provider is required to meet the monitoring and reporting requirements as laid out within this specification.

6.5

The Purchaser may undertake a visit to the Pharmacy to inspect the provision of the service and to ensure that the Provider is meeting the service specification.

SERVICE SPECIFICATION REVIEW 7.1

It is recognised within this specification that the Service may be subject to change due to a range of national and local policy initiatives. For example, government guidance and legislation, industry professional standards, NICE Guidance, Public Health England or Dorset County Council Policy.

7.2

The Service Specification shall be reviewed annually and updated to reflect the changes in legislation. Adequate notice will be given to the Provider of any significant changes which may impact on the service provided and will ensure sufficient transition arrangements are agreed to ensure service continuity.

FINANCIAL INFORMATION Payment and Reimbursement Structure 8.1

A fee of £12 will be paid to the Provider for each occasion that a supervised dose of Azithromycin is supplied.

8.2

A fee for the cost according to provision (and subject to BNF rate changes) of £11.66 (£9.72 + £1.94 VAT) will be paid to the Provider for the Drug Tariff Price (including VAT) of the Azithromycin tablets.

8.3

A fee of £1.50 will be paid to the Provider for the supply of a pack of 3 condoms (including VAT at 5%)

8.4

A fee of £2.50 will be paid to the Provider once a completed screening kit (issued to a sexual contact) has been tested by the Laboratory Diagnostics Provider. 8.4.1 8.4.2

Pharmacies are not required to make any additional claims for payment as activity data is accessible directly to Public Health Dorset The Laboratory Diagnostics Provider will invoice Public Health Dorset directly for test kits provided to pharmacies and processed through the lab.

Claims for Payment 8.5 Payment will be based on the returns of the faxed Communication Forms to the Chlamydia Screening Office. 8.6

Payment will be made on a quarterly basis.

8.7

No claim should be submitted more than one month after the end of this agreement.

8.8

Claims for activity more than 6 months (two quarters) old will not be paid.

Dorset County Council Dorset Procurement, Level 3, North East Wing, County Hall, Colliton Park, Dorchester, Dorset, DT1 1XJ

DORSET COUNTY COUNCIL Public Health

Page 7 of 10

Appendix A – Communication Form CHLAMYDIA TREATMENT THROUGH PHARMACY

SECTION A: To be completed by the CSO to confirm Service User needs treatment and faxed to contacted pharmacy to request treatment: POSITIVE SERVICE USERS

SERVICE USER NUMBER Date tested

Name

Place tested

Telephone No

D.O.B

Mobile No Is the Service User a contact?

Yes

No

Date & Time of Treatment confirmed with telephone call to Pharmacy Date and Time of Treatment confirmed with Service User Comments:

Confirm which number for followup calls If yes, Index Service User’s No.

Referred for Treatment by CSO

Age

Sex

Tele

Mbl

Print Name: …………………………………….. Signature: ……………………………………….

Dorset County Council Dorset Procurement, Level 3, North East Wing, County Hall, Colliton Park, Dorchester, Dorset, DT1 1XJ

DORSET COUNTY COUNCIL Public Health

Page 8 of 10

SECTION B: To be completed by the PHARMACY to confirm Service User accessed treatment and faxed back to the CSO: 1. CONTACT SERVICE USERS ONLY Test pack Complete given screening record with contact (Blue Form)

D Number of Test Pack:

2. ALL SERVICE USERS (POSITIVES / CONTACTS) Azithromy Treatme None cin nt given 1g once only If none, why? Azithromycin PGD Consultation Form Yes completed? Route Batch Number PHARMACIST Print Name

No

……………………………………………………………………………… ……………….

Signature Date

Discu ss

……………………………………………………………………………… ………………. …………………………………… VENUE CODE OF PHARMACY ………………….. How to Side Sexual Informe take Effect Health Advice d of + Condoms medicati s GUM given on (PGD service (PGD) ) s (leaflet)

Dorset County Council Dorset Procurement, Level 3, North East Wing, County Hall, Colliton Park, Dorchester, Dorset, DT1 1XJ

DORSET COUNTY COUNCIL Public Health

Page 9 of 10

Appendix B Care Pathway for Chlamydia Positive Service Users Attending Satellite Treatment Venues including Pharmacy Positive result received by Chlamydia Screening Office

Contact made to Service User by preferred method as indicated on request form Responds to office number

Does not respond to office number

Positive result given and discussed

Attempt contact by preferred method x2

Contact tracing commenced on telephone

If no response, contact using secondary method x3

Antibiotic treatment and choice of treatment venues discussed

If no response, try to contact via testing venue

Chlamydia Screening Office

Pharmacy selected as treatment venue

Alternative venue

Suitable date and time arranged

Pharmacy contacted by CSO to confirm availability

Arrange suitable time and date

CSO Fax Treatment referral to Pharmacy

Confirm with Service User

If unsuccessful file to drawer

Service User attends Pharmacy for treatment

Pharmacist completes Azithromycin PGD Consultation Form

If Service User is not appropriate, make an urgent referral back to the locally commissioned Sexual Health provider

Pharmacist completes Section B of referral and faxes back to CSO

Follow up phone call made at 10 days to confirm treatment and continue contact tracing

Dorset County Council Dorset Procurement, Level 3, North East Wing, County Hall, Colliton Park, Dorchester, Dorset, DT1 1XJ

DORSET COUNTY COUNCIL Public Health

Page 10 of 10

Appendix C Useful Contacts Contraceptive and Sexual Health Clinics (CASH) 20 Trinity Street Dorchester DT1 1TU Main Office: 0300 3031948 Confidential Fax: 01305 260994 Joanne Goodman Chlamydia Screening Lead Nurse (Pan-Dorset) Office: 0300 3031948 (Dorset) / 0844 800 4846 (B&P) Mobile: 07920 274 124 E-mail: [email protected] Pete Knight C&SH Administrator (with responsibility for Chlamydia Screening) Office 0300 303 1948 E-mail: [email protected] Helen Toon Health Advisor Office: 0300 3031948 E-mail: [email protected] G.U.M Clinic for Sexual Health (Genito-urinary Medicine) G.U.M clinic Sexual Health Clinic Melcombe Avenue Weymouth DT4 7TB Main Office: 01305 762682 Fax: 01305 762697 Useful websites: www.keeplovesweet.co.uk

Dorset County Council Dorset Procurement, Level 3, North East Wing, County Hall, Colliton Park, Dorchester, Dorset, DT1 1XJ

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