Locally Commissioned Services Herefordshire

SUBSTANCE MISUSE

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Contact

Sam Brookfield
Addaction
6 Bridge Street
Hereford
HR4 9DF
Tel: 01432 803 487
Email: sam.brookfield@addaction.org.uk


Supervised Consumption SLA v3

Needle Exchange SLA v4

Number of adults in contact with drug and alcohol treatment services in England is almost 290,000.¹

The pharmacist is required to supervise the consumption of a medicine prescribed to the patient, for the purposes of dependence and/or addiction to ensure the entire dose is taken as directed. Common medicines which may have to be supervised include methadone and buprenorphine.

Pharmacies can also provide harm reduction items such as clean needles, sharps bins, swabs and citric acid as well as sexual health advice. Any used equipment can be returned for destruction in a safe sharps disposal bin.

The aim of these services is to reduce the harms associated with drug taking to the service user and on the wider society. The service user will be given help, support and signposting to additional services in a non-judgemental and confidential service.


Additional support and commonly asked questions.

  • How do I become accredited to provide the needle exchange service in Herefordshire?
  • How do I become accredited to provide the supervised consumption service in Herefordshire?
  • Do I need a Hepatitis B vaccination to provide these services?
  • How does the Pharmacy get paid for providing the needle exchange service?
  • What are the monitoring requirements for the needle exchange service?
  • How does the Pharmacy get paid for providing supervised consumption?
  • I have a concern about a service user, what should I do?
How do I become accredited to provide the needle exchange service in Herefordshire?

Addaction training for Pharmacy staff will include appropriate related topics including basic drugs awareness, referral, health promotion, and approach to treatment, local issues/developments and national guidance. Attendance at the first session on initiation of accreditation and service provision and then at least one session per year is compulsory for the Pharmacist(s)/Pharmacy Manager/Pharmacy Technician(s) accredited to oversee the service in each participating Pharmacy.

It is also a requirement for the Pharmacist(s) and/or Pharmacy Technician(s) at each Pharmacy to complete the most recent CPPE Declaration of Competence for Needle Syringe Provision within 6 months of commencing service provision.

It is the responsibility of the accredited Pharmacist(s) / Pharmacy Manger / Pharmacy Technician(s) of the participating Pharmacy, to ensure all their staff including locums involved in the provision of the Service have relevant knowledge and are appropriately trained in the operation of the Service. This will be monitored as part of Contract and Performance Management by Addaction. The Pharmacy must also have provided the staff with appropriate health and safety training, including the safe handling of injecting equipment, an overall understanding of the Service and its harm reduction ethos, and the importance of maintaining confidentiality.

The area of the Pharmacy used for the provision should provide a sufficient level of privacy and safety for the service user, public and staff. A consultation area/private room is not essential; however if used a risk assessment must be undertaken.

How do I become accredited to provide the supervised consumption service in Herefordshire?

Addaction training events will be held regularly (at least annually) and the content will be available to all of the pharmacy team, even if they are not currently involved in provision of the Service. Training for pharmacy staff will include appropriate related topics including basic drugs awareness, referral, health promotion, the harm minimisation approach to treatment, feedback on learning from incidents, developments, and national guidance.

Attendance at the first session on initiation of accreditation and service provision and then at least one session per year is compulsory for the Accountable Pharmacist(s) and/or Pharmacy Technician(s) accredited to oversee the Service in each participating pharmacy.

It is also a requirement for the accredited Pharmacist(s) and/or Pharmacy Technician(s) at each pharmacy to have completed in the last two years or go on to complete the latest CPPE Distance Learning Package on “Substance Use and Misuse” within 6 months of commencing service provision. Pharmacists must incorporate this to complete a CPPE Declaration of Competence (DoC) for Supervised Consumption of Prescribed medicines and ensure it is reviewed regularly.

It is the responsibility of the accredited Pharmacist(s) and/or Pharmacy Technician(s) of the participating pharmacy to ensure their staff have been provided with appropriate training, this will include health and safety, an overall understanding of the Service, relevant SOPs and the importance of maintaining confidentiality.

In the event of changes to the accountable, accredited pharmacist or technician then Addaction will be informed within 6 weeks of the situation. A new accountable pharmacist/technician will be allowed 3 months to complete the required CPPE training/DoC to take over as the replacement pharmacist. The accredited/lead pharmacist must work at least three days a week in the pharmacy. Where locums or part time pharmacists predominantly operate a pharmacy, the area manager pharmacist or equivalent must nominate a lead technician/manager to act as a contact in this store. This must be communicated to Addaction promptly.

The Responsible Pharmacist on duty at any time will retain professional responsibility and liability for the Service. In line with this, the pharmacy employing locums must ensure the locums employed are suitably trained as described to operate a supervised consumption service. Locums must be encouraged to attend the training events put on by Addaction.  The lead pharmacist/registered technician must ensure all their staff are fully trained on the supervised consumption scheme and relevant SOPs, health and safety and other associated aspects.

Where PharmOutcomes or similar is used it is imperative that communication section is regularly checked on there and actions requested implemented. This is because it may be employed to send critical alerts and updates. Failure to do this could jeopardise payment.

Do I need a Hepatitis B vaccination to provide these services?

It is not a requirement but it is recommended.

How does the Pharmacy get paid for providing the needle exchange service?

Payment will be made to the Pharmacy on combination of a per harm reduction visit basis and an annual retainer paid quarterly when activity is recorded. The payment schedule will be as follows):
£2.00 per supply of equipment and harm reduction interaction including recorded amount of returns.
£75 paid quarterly (£300 per year) triggered by recorded activity.

Payment will be made monthly in arrears by Addaction upon receipt of an invoice from the Pharmacy that arrives no later than the 5th day after the end of the month. Payments will only be made where Addaction is satisfied that the Service has been provided in accordance with the terms of this Agreement and will make best endeavours to pay within 30 days of receipt of the Pharmacy’s invoice.

This service is VAT exempt. Please see the SLA for full details on payment terms.

What are the monitoring requirements for the needle exchange service?

The Pharmacy will be required to collect basic anonymous information from service users at each visit. This information will be recorded on a computer on a web based monitoring facility, as appropriate (e.g. PharmOutcomes). Recording of information should take place in a timely manner by the 5th of the following month.
On a monthly basis copies of the monitoring forms will be sent to Addaction by the web provider to generate payment. Any events not recorded on the system will not generate payment.
Service reviews are undertaken by Addaction where and when required, including those investigating client satisfaction of services to ensure compliance with this Service Specification.

How does the Pharmacy get paid for providing supervised consumption?

Payment will be made to the Pharmacy on a per supervision basis/or amend as local agreement but per supervision is ideal. The payment schedule will be as follows:
(i) Supervision of methadone – £2 per supervision (ii) Supervision of sublingual tablets (i.e. buprenorphine, Subutex, Suboxone) – £2.75 per supervision.

This will be paid monthly in arrears with the expectation that the Pharmacy will accept a minimum of 5 clients at any one time, subject to the service being able to refer 5 clients. The Service as outlined is VAT exempt, both Parties are aware of this exemption. However, if in the future the VAT status was to change then the Pharmacy would be made aware of this change, and an opportunity to renegotiate the terms of the Agreement would be made available.

I have a concern about a service user, what should I do?

Contact the appropriate safeguarding board:

https://herefordshiresafeguardingboards.org.uk/


Reference
(1) National Treatment Agency, www.nta.nhs.uk/facts

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