Download Drug_Misuse_LES_Pharmacy_2011_12

OLPC A0901/04b
Oxfordshire Primary Care Trust
Drug Misuse Local Enhanced Service
Oxfordshire
Oxfordshire Drug and Alcohol Action Team
and Oxfordshire Primary Care Trust
Partnership
Local Enhanced Service Specification for
Community Pharmacists providing a
Drug Misuse Service 2011-2012
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OLPC A0901/04b
Oxfordshire Primary Care Trust
Drug Misuse Local Enhanced Service
Oxfordshire
SLA 2011-2012
Service Level Agreement 019/DAAT
The Service Level Agreement commenced on the 1st day of April 2011 and shall continue in force until
the 31st day of March 2012 unless terminated in accordance with point 4. The Commissioner may at
their discretion propose to the Provider that the Agreement should be extended for up to twelve month
plus twelve month roll on period thereafter. The DAAT/PCT reserves the right to amend categorisation
(i.e. Band 1, Band 2). All providers accepted onto this agreement must at all times, meet the appropriate
required standards as detailed below.
The pharmacy must be complying with community pharmacy contractual service framework for
essential services before entering into this agreement.
The Oxfordshire DAAT wishes to provide funding to the Pharmacy Contractor under a Local Enhanced
Service (LES) in a partnership with Oxfordshire Primary Care Trust (PCT) for the provision of a Drug
Misuse Service on the terms and conditions appearing below.
In accepting funding the Organisation agrees to the following:
PRACTICE
1.
The Conditions of this Service Level Agreement may only be varied by written agreement of the
Oxfordshire DAAT in partnership with the Oxfordshire PCT and the Pharmacy Contractor.
2.
In the event that the Pharmacy Contractor fails to provide the Services in accordance with this
Agreement and Schedule one to four attached, the Oxfordshire DAAT, in conjunction with the
Oxfordshire PCT, reserve the right to withhold funding until the default is rectified.
3.
The Pharmacy Contractor shall at all times maintain insurance cover with a reputable company to
include: Public Liability in the sum of a minimum of £5,000,000 (five million) per claim and Employers
Liability in the sum of £5,000,000 (five million) per claim.
4.
TERMINATION
This Service Level Agreement may be terminated by either party at any time by normally giving three
months notice in writing to the other party.
The Signatories may at their discretion terminate this agreement with immediate effect if either party is
in serious breach of the agreement.
5.
WAIVER
Oxfordshire DAAT may waive any provision of Conditions of this Service Agreement provided that any
such waiver is confirmed in writing and signed by the DAAT Director.
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Oxfordshire Primary Care Trust
Drug Misuse Local Enhanced Service
6.
Oxfordshire
SIGNATURES
Name of Pharmacy: …………………...……………......... Maximum patients to be supervised: ....…........
Address:……………………………………....................................................................................................
Email address: ...........................................................................................................................................
Tel: ................................................................
Fax:.........................................................
Signed on behalf of the Contractor: ………………………………………….................................................
Please Print name:……………………………………………………................. Date:.................................
Signed On behalf of Oxfordshire DAAT and PCT
………………. ………....................................................................................
(DAAT Director)
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Date: ……..................……
OLPC A0901/04b
Oxfordshire Primary Care Trust
Drug Misuse Local Enhanced Service
1.
Oxfordshire
Background
All pharmacies are expected to provide essential services as per the pharmacy contract and any
enhanced services are commissioned by local agreement. This enhanced service specification
outlines the more specialised service to be provided for drug using patients under the Substance
Misuse scheme co-ordinated by the Drug and Alcohol Action Team (DAAT) and Primary Care Trust
(PCT) partnership, supported by the Local Pharmaceutical Committee (LPC), through the Shared
Care Management Group (SCMG). No part of the specification by commission, omission or
implication defines or redefines essential or advanced services.
Introduction to the specification
There are two possible levels of participation for pharmacy contractors in the care of drug users:
 local enhanced services
 national enhanced services
This specification is concerned solely with a local enhanced service (LES).
2.
Specification-Service description
Aim The principle aim of the Drug Misuse service in the clinical context is to provide a
comprehensive, service to drug users that will reduce drug-related harm and the potential for death.
This will usually involve substitute prescribing of either methadone or buprenorphine. It is based upon
the multi-disciplinary partnership between GPs, Specialist Community Addiction Service (SCAS)
nurses, Non-Medical prescribers, community pharmacists and the patient.
For pharmacies the aim is to:
 Ensure compliance with an agreed care plan
 Reduce the risk to local communities
 Provide service users with regular contact to healthcare professionals
 Provide referral or signposting to other related services
 Support achievement of NTA targets in relation to delivering the Drug strategy at a local level
2.1
2.2
2.3
2.4
2.5
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This service will require the pharmacy to provide a Drug Misuse Service to patients over
eighteen years living in Oxfordshire; capacity will be determined by the pharmacy in agreement
with the DAAT & PCT partnership
The Pharmacy will offer a user-friendly, non-judgmental, patient-centred and confidential
service
The Pharmacy will work in partnership with Specialist Community Addiction Nurses, NonMedical Prescribers (NMPs) and General Practitioners as part of the drug misuse service.
The Pharmacy will promote harm reduction to the patient, carer and families and referral
to
drug services as relevant.
Desired Outcomes
 Patients are able to gain quick and efficient access to services
 Reduced complications from drug use
 Retention of patients in treatment
 Improved professional, user and carer satisfaction
OLPC A0901/04b
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Drug Misuse Local Enhanced Service
Oxfordshire
 Prevention of transmission of blood borne viruses associated with drug use.
3.
Service Outline
The prescriber requests supervision of consumption of a substance used in the treatment of opioid
addiction, on a regular basis, either as part of a detoxification programme or maintenance treatment
3.1
3.2
3.3
‘Regular’ is defined to mean ‘weekly for a minimum of four weeks’ or as ‘a minimum of six
consecutive days’
Patients are prescribed methadone solution 1mg in 1ml or buprenorphine sub-lingual tablets
Prescriptions are issued from:
 Specialist Community Addiction Service (SCAS) Oxford Health NHS Foundation Trust
 Rapid Prescribing Clinic-Drug Intervention Programme (DIP)
 Oxfordshire Drug Treatment Clinics
 GP practices providing Shared Care LES
 HMP Bullingdon or other prisons for Oxfordshire residents
3.4
4.
Prescriptions are issued by:

SCAS medical prescribers

SCAS non-medical prescribers

GPs from a Substance Misuse practice

Medical Practitioners working in a Drug Treatment Clinic
Criteria for participation in the scheme
4.1
Band One
The pharmacy should:
4.1.1 Identify a pharmacist who has successfully completed either the distance learning pack
Substance use and misuse CPPE 2010 or RCGP Part One Certificate in the
Management of Drug Misuse (or equivalent as approved by the Oxfordshire DAAT &
PCT partnership) to take responsibility for the service on the premises
4.1.2 Comply with Guidance for Primary Care Drug Misuse Oxfordshire DAAT and NHS
Oxfordshire 3rd Edition 2010 ( or more recent edition), professional guidance and
national treatment guidance
4.1.3 Use a patient medication records system
4.1.4 Provide safe storage conditions for the supply of methadone and maintain appropriate
standard operating procedures for the safer management of controlled drugs
4.1.5 Provide advice on safe storage of methadone and buprenorphine at home
4.1.6 Follow PCT procedures for documenting and processing a serious untoward incident
4.1.7 Provide advice and display health promotion leaflets relating to harm reduction
4.1.8 Maintain sufficient staff in place to provide and/or support the service
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4.1.9 Provide a continuous service on all days of opening
4.1.10 Provide access for locum staff, to standard operating procedures for ‘the Substance
Misuse Service *
4.1.11 Provide hours of service to meet the Substance Misuse service
4.1.12 Provide a system to assess service user satisfaction
4.1.13 Provide safe disposal and destruction of clinical waste and items which may identify
patients.
4.2
Band Two
A Band Two pharmacy will be determined by need, as agreed by the Oxfordshire DAAT and
PCT partnership but the following criteria must be met in addition to the above.
A Band Two pharmacy will have:
4.2.1 A pharmacist who has completed the RCGP Certificate Management of Drug Misuse
Parts One and Two and working a minimum of 20 hours per week in the named
pharmacy
4.2.2 A minimum of twenty patients regularly supervised on a continual basis
4.2.3 A private consultation area which must meet the following principles:
a. The user and the pharmacist can sit down together
b.
The user and pharmacist can talk at normal speaking volumes without being
overheard by staff or customers
c.
The area is clearly signed as a private consultation area (a closed room is not
necessary).
*Absence of an accredited pharmacist would normally be considered for days off, holiday or sick
leave, for periods extending no longer than 4- week duration.
5.
Roles and Responsibilities
The pharmacist will provide a level of service as determined by the banding of the LES set out in
Guidance for Primary Care Drug Misuse 3rd Edition Oxfordshire DAAT and NHS Oxfordshire 2010 (or
more recent version) and see Appendix One.
5.1
Band One
The pharmacist will:
5.1.1 Manage patients according to Guidance for Primary Care Drug Misuse 3rd Edition Oxfordshire
DAAT and PCT 2010 (or more recent version) see Appendix One
5.1.2 Take on the number of patients by agreement with Oxfordshire DAAT/PCT that he/she feels is
appropriate for the pharmacy, without affecting or compromising the quality of services
provided to other patients/customers or the neighbourhood in general
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Drug Misuse Local Enhanced Service
Oxfordshire
5.1.3 Comply with monitoring and auditing requirements of the Oxfordshire DAAT/PCT
5.1.4 Demonstrate evidence of maintaining skills and training appropriate to the individual and
service
5.1.5 Dispense prescriptions for titration of treatment, reduction and detoxification and long term
maintenance treatment
5.1.6 Provide supervision for consumption as per the Guidance for Primary Care Drug Misuse
5.1.7 Refer patients for access to assessment, to appropriate treatment services
5.1.8 Report concerns involving controlled drugs to the PCT Accountable Officer,
5.1.9 Conform with the PCT serious untoward incident policy.
5.2
Band Two
In addition to the above, pharmacists will be expected to:
5.2.1 Identify issues with concordance and compliance and seek to resolve issues
5.2.2 Be trained and experienced in dealing with Substance Misuse issues
5.2.3 Maintain competencies as per RCGP Certificate in the Management of Drug Use
5.2.4 Work with Oxfordshire DAAT/PCT (LPC) to develop and expand a specialist role subject to
agreed negotiation
5.2.5 Provide support and advice to colleagues and other professionals.
6.
Monitoring
6.1
A minimum data set should be recorded on a monthly basis using Neo the web-based data
system, data should be retrievable by the DAAT within 7 days of the end of the previous month
6.2
The Shared Care Management Group (SCMG) will monitor the scheme on behalf of the
DAAT/PCT partnership.
7
Audit/Review
7.1 The pharmacy participates in DAAT/PCT organised audit of service
7.2 The pharmacy participates in audit of prescribing
7.3 The pharmacy co-operates with any locally agreed DAAT/PCT assessment of service user
experience
7.4 The pharmacy can demonstrate that key staff have undertaken CPD relevant to this service
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Drug Misuse Local Enhanced Service
Oxfordshire
7.5 The Shared Care Management Group (SCMG) will review the service on behalf of the
DAA/PCT partnership and LPC, on a regular basis as well as responding to issues which may
require a more urgent review
7.6 Review of the LES will take place on an annual basis by the Shared Care Management Group
or earlier if required
8
Oxfordshire DAAT and PCT Partnership
The Oxfordshire DAAT and PCT Partnership will:
8.1
Provide a direct point of contact for service provision:
Substance Misuse: Pharmacist- Tel 01865 290800
8.2
Support pharmacies through training, visits and phone calls as appropriate and relevant
8.3
Provide a Service Directory of drug related services in Oxfordshire
8.4
Provide details for referral points or signposting to other relevant services for service users
8.5
Provide harm reduction literature for service users, carers and families subject to funding and
availability.
9
Finance
The Oxfordshire DAAT /PCT partnership will pay the pharmacy:
9.1
Band One pharmacies = £26.95 per patient per month.
9.2
Band Two pharmacies= £26.95 per patient per month plus £1,500 retainer
9.3
The retainer will be paid at the start of the financial year and a monthly fee will be paid based on
the numbers of individuals supervised for that month
9.4
Payments will be paid in the proceeding weeks following the given month through Oxfordshire
PCT finance system
9.5
Any queries regarding payments should be taken up initially with the DAAT Substance Misuse
Pharmacist.
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Drug Misuse Local Enhanced Service
Oxfordshire
Appendix One Responsibility:Extract
Guidance for Primary Care Drug Misuse 3rd Edition Oxfordshire DAAT and NHS Oxfordshire 2010
Community Pharmacist
Drug Misuse Local Enhanced Service
Pharmacists provide Shared Care for patients within the scope of the Drug Misuse LES, when a
prescriber requests supervision of consumption for either methadone or buprenorphine within the
following criteria:

On a daily basis, minimum 6 days of treatment

On collection of a regular prescription for take home with a minimum supervision of once a
 week at point of dispensing.
The prescriber should be:
 A GP from a Shared Care practice
 A supplementary prescriber working within a GP shared care practice
 A prescriber from SCAS (supplementary and medical prescribers)
 A prescriber from the Rapid Prescribing Clinic/ DIP Clinic
 A prescriber from a Drug Treatment Clinic (supplementary and medical prescribers).

There are two levels of service within the LES that a pharmacist may provide.
Band One Pharmacist will:

Develop and maintain standard operating procedures for the delivery of Shared Care
 Provide the patient with both written and verbal information about their medicines

Provide information on the safe storage of medicines

Supervise either methadone or buprenorphine as requested at the point of dispensing (see
 Appendix 14)

Refer and collaborate with the GP and or addictions nurse, where appropriate, on a need to
know basis.
Pharmacists are encouraged to ask patients to sign a consent form
(see Appendix 12)









Review and feedback on the patient’s progress at the request of the GP or addiction nurse,
Provide a valuable link when a patient transfers from one service to another
Provide written information on harm reduction, and sexual health (subject to availability)
Promote the uptake of hepatitis A and hepatitis B vaccination and screening for hepatitis B, C
and HIV
Promote, advise and signpost on general health issues, dental care
Signpost and provide information on drug related services
Provide a continuous service when locum cover is used
Adhere to the Safeguarding Children guidance from the Oxfordshire Safeguarding Children
Board (OSCB) http://www.oscb.org.uk/; identifying any change for patients’ regarding access to
children and supporting appropriately.
Band Two
A Band Two pharmacy will be determined by need, as agreed by the Oxfordshire DAAT and NHS
Oxfordshire partnership but the following criteria must be met:
A Band Two pharmacy will have a pharmacist who has completed the RCGP Certificate
 Management of Drug Misuse Parts One and Two
 The pharmacy premises are accredited by the PCT for advanced services
 The pharmacy will be routinely supervising a minimum of twenty patients.
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OLPC A0901/04b
Oxfordshire Primary Care Trust
Drug Misuse Local Enhanced Service
Oxfordshire
Band Two pharmacists/pharmacies will provide the same service as for Band One and the following:
 Act as a resource for other pharmacists and healthcare professionals, to share knowledge and
 experience and offer support
 Advise healthcare professionals on medicines management for patients receiving substitute
 prescribing and other medicines

Provide both verbal and written advice on harm reduction methods, for a wide range of drug
 users

Be willing to develop or pilot a specialist role subject to agreed negotiation

Offer training at a local level for healthcare professionals or frontline staff as required
 Liaise with the GP/SCAS worker on recommended doses for individual patients
 Refer for vaccination and testing for BBVs and HIV.
Pharmacists: Roles & Responsibilites for Shared Care
7
Contacting the GP or Addictions Nurse
Pharmacists will contact either the prescriber or addictions nurse when:
 The patient fails to turn up for a collection or supervision
 The patient turns up after an absence of three days or more
 The patient continually misses odd days of treatment
 The patient exhibits unacceptable behaviour (based on the pharmacist’s professional
judgement), which may result in a ban
 The patient presents in an intoxicated state and treatment is withheld
 The pharmacist is concerned at the observed deterioration in the health of a patient
 The pharmacist believes the patient may benefit from a dose alteration or increased/ decreased
 rate of supervision
 The pharmacist is concerned about possible drug interactions with the patient’s other
 prescribed drug therapies
 The pharmacist believes there may be a concordance issue with other prescribed drugs
 The patient indicates to the pharmacist that he/she, and maybe their family, would like to be
 vaccinated for hepatitis A and B or screened for hepatitis C
 The pharmacist suspects the supervised client has not consumed the whole dose
 A patient or carer requests supervision
 The pharmacist believes the patient may have additional social problems that affect
 compliance (e.g. client has been made homeless)
 The pharmacist is informed by the patient that he/she is leaving treatment or changing
pharmacies.
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