Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Prenatal testing wikipedia , lookup
Reproductive health wikipedia , lookup
Public health genomics wikipedia , lookup
Fetal origins hypothesis wikipedia , lookup
Health equity wikipedia , lookup
Patient safety wikipedia , lookup
Infection control wikipedia , lookup
Adherence (medicine) wikipedia , lookup
Race and health wikipedia , lookup
Rhetoric of health and medicine wikipedia , lookup
Community Pharmacy NHS Health Checks 2010/11 2011/12 Service Specification March 2010 Version control Version number V1 Date Author/Editor Changes/comments 30/9/09 Neemisha Tailor V2 V3 8/10/09 16/11/09 Julie Billett Ian Sandford V4 26/11/09 Ian Sandford V5 8/3/10 Ian Sandford Revised following interval project group meeting and feedback from J Billett. Further revisions/edits. Revision of thresholds etc, references added. Clarification of payment mechanisms/dates (section 13) Final review Community Pharmacy NHS Health Checks Service Specification 2010/11 Contents 1. Purpose 2 2. Description of the Health Check service in community pharmacy 3 3. Scope 10 4. Patient pathways 12 5. Service Delivery 16 6. Referral, Access and Acceptance Criteria 17 7. Equipment 18 8. Patient and Carer Information 19 9. Quality Assurance 19 10. Marketing and Publicity 20 11. Activity 20 12. Payments to pharmacies 20 13. Information Governance 21 14. Monitoring, Evaluation and Service Improvement 22 15. Duration and Annual review 22 1 1. Purpose 1.1 Aims The NHS Health Check programme is a national programme, launched in 2008, which aims to assess and manage individuals’ cardiovascular risk. In doing so, it intends to prevent the development of cardiovascular disease, including coronary heart disease, diabetes and chronic kidney disease, and reduce the incidence of heart attacks and stroke. As part of its local delivery of the NHS Health Checks programme, NHS Islington will commission is commissioning NHS Health Checks in community pharmacies. These opportunistic community pharmacy Health Checks will support the early identification of cardiovascular risk factors in 35 to 74 year olds across the most deprived wards in Islington. Up to ten community pharmacies will be commissioned to provide a cardiovascular risk assessment (Health Check) enhanced service. In addition to identifying and assessing cardiovascular risk factors, the programme seeks to support people to manage their risk through lifestyle advice, onward signposting and referral for additional support and pharmacological interventions where indicated. 1.2 Context and Evidence Base Cardiovascular disease (CVD) is the biggest killer in London and the largest cause of health inequalities. Cardiovascular disease differentially affects black and minority ethnic groups and socially disadvantaged populations. Islington is an area of multiple deprivation, ranked the eighth most deprived borough in England, and fourth in London. Deaths from CVD are the single largest contributor to the inequalities gap in life expectancy between Islington and England. The life expectancy for men and women in Islington (2005 - 2007) is 75.1 and 80.8 years respectively. This is significantly lower than that for men and women in England (77.7 and 81.8 years respectively).1 Rates of CVD mortality are higher in Islington than the average for England and Wales (E&W). Directly standardised mortality rates from all causes of cardiovascular disease in Islington are 240 per 100,000 compared with 193 per 100,000 population for England and Wales. Premature mortality rates for individuals below 75 years in Islington are also significantly higher than for England and Wales (120 per 100,000 compared to 79 per 100,000 population). (All data are for the 3 year period 2005-2007).2 Vascular disease also causes significant morbidity and poor quality of life for individuals who are affected by it. The Department of Health has predicted that full implementation of the NHS Health Check programme nationally will prevent at least 9,500 heart attacks and strokes a year (2,000 of which would be fatal), and prevent 4000 people from developing diabetes each year.3 1.3 Overview of NHS Health Checks in Community Pharmacy Ten community pharmacies that meet the eligibility criteria (refer to section 3.1) will be commissioned to opportunistically identify patients aged 35 to 74 years, who are registered with an Islington GP (or who are resident in Islington and not registered with any GP) and are not currently being treated for CVD, diabetes, atrial fibrillation or peripheral artery disease. They will opportunistically assess individuals in order to establish their risk of developing cardiovascular disease over the next 10 years, through completion of a questionnaire, simple measurements and finger-prick blood testing. Following the cardiovascular risk assessment, pharmacists will offer individuals a tailored package of advice, support and signposting to enable them to manage and reduce their risk. Please note that the term NHS Health Check was previously known as the Vascular Risk Assessment or Vascular check, and these terms are often used interchangeably. National Centre for Health Outcomes Development http://www.nchod.nhs.uk/ National Centre for Health Outcomes Development http://www.nchod.nhs.uk/ 3 Department of Health (2008) Putting prevention first Vascular Checks: risk assessment and management. 1 2 http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digi talasset/dh_083823.pdf 2 1.4 Objectives To conduct 2000 NHS Health Checks per annum in a community pharmacy setting on eligible individuals aged 35 to 74 year olds across Islington. Each commissioned community pharmacy will be expected to meet an indicative quarterly target of 50 Health Checks. 2. Description of the Health Check service in community pharmacy Figures 1 and 2 (pages 14 and 15) provide a diagrammatic overview of the Health Check programme. The NHS Health Check will take place in a private consultation room and will be conducted as a face-to-face check between the pharmacist and the individual. Delivery of an NHS Health Check in a community pharmacy setting comprises the following three main components: The initial assessment process Recall and Referral Life style advice, support and signposting Each of these components is described in more detail below. 2.1 Phase I: The initial screening process All individuals participating in the NHS Health Check will be required to sign a consent form. Pharmacists will print out this consent form using the dedicated software package in order for this to be signed and a copy retained by the pharmacist. Individuals will not receive an assessment without signing the consent form. The initial screening session and NHS Health Check will be facilitated by a dedicated software package (Cardiopod) and will include an assessment of lifestyle habits and a range of health measurements and tests. These standard questions and assessments are described below. Standard questions: Age (calculated from date of birth and recorded in years) Gender (recorded as male or female) Ethnicity (self assigned from a pre-defined list) Patient’s address and postcode Registered GP (state postcode/location/name of GP practice- selected from a drop down list) Smoking status (recorded as smoker or non-smoker) Alcohol consumption based on the AUDIT-C Screening Tool Physical activity based on GPPAQ Consumption of fruit and vegetables Family history (any history of coronary heart disease, in a first degree relative under the age of 60 years. First degree relative means biological mother, father, brother or sister) Known pre-existing cardiovascular disease, diabetes, atrial fibrillation or peripheral artery disease Current prescriptions specifically for the treatment of cardiovascular disease (includes aspirin, beta blockers, calcium channel blockers, ACE inhibitors, A2 receptor blockers, alpha blockers, diuretics, and other medications used to treat CVD). Measurements: Height (recorded in cm) and Weight (recorded in kg) for calculating Body Mass Index (BMI) Blood pressure measurements (recorded in mmHg) Simple blood test: (Finger-prick test): Total cholesterol (TC) and HDL cholesterol (non-fasting) (for all individuals receiving an NHS Health Check). Fasting blood glucose (for selected patients who meet the specified criteria - refer to section 2.2.3) 2.1.1 CVD risk score and risk communication Using the standard information obtained from the patient, the dedicated Health Check software package will then generate a CVD risk score for the individual. The risk score uses the QRISK2 risk engine. The QRISK2 engine, validated for use in the UK, gives a risk score which takes into account factors such as ethnicity, 3 family history, and deprivation status. For these reasons, QRISK2 is the preferred risk engine for use in Islington. 4 All individuals accessing the service should receive a full explanation of their results and be provided with a printed copy of them, along with relevant information on health lifestyles and provided documentation by the accredited pharmacist. Depending upon the results of their Health Check, individuals will be offered a range of appropriate advice and support (see sections 2.2 and 2.3 below). This will include: 2.2 Lifestyle advice: o Smoking cessation advice for smokers, and referral to in-pharmacy or other local smoking cessation services for ongoing support and encouragement to quit o Dietary advice, healthy eating and ways to increase fruit and vegetable consumption o Advice on sensible alcohol consumption o Advice on keeping active and getting involved in regular exercise. Individuals will be referred to the Exercise on Referral (EoR) scheme, where they meet the criteria for inclusion (see section 2.3.5 for EoR criteria) o Referral to a health trainer, where the individual meets the eligibility criteria for the health trainer programme. Recall back to the community pharmacy for a fasting blood glucose and repeat BP measurement for eligible patients (see paragraphs 2.2.2 to 2.2.4). Referral to their GP for further assessment. In this service level agreement “GP” means “General Practitioner” or “Practice Nurse”, depending on their individual circumstances and their registered practice’s policies. Phase II: Recall and Referral 2.2.1 Individuals requiring direct referral to their GP (HIGH RISK) The high risk group includes all individuals with a 10-year CVD risk score ≥20%. In addition, individuals with a 10-year CVD risk score <20% but who are found to have any one of the additional risk factors described below will also be included in the ‘high risk’ group. These individuals will require direct referral to their GP for further assessment, review of their risk factors and pharmacological interventions where indicated. The pharmacist conducting the assessment should offer a full explanation of the individual’s CVD risk and the reason for referral, and provide lifestyle advice on managing CVD risk. The following individuals require direct referral to their GP or practice nurse, based on the results of the initial screen (Phase I of the NHS Health Check): Individuals with a 10-year CVD risk score (QRisk2) ≥ 20 % should be asked to see their GP within 4 weeks Individuals with a Blood Pressure ≥ 160/100mmHg, or with an isolated systolic or diastolic BP reading ≥ 160 or ≥ 100mmHg respectively, irrespective of their 10-year CVD risk score.5 Individuals with a random cholesterol reading ≥ 7.5 mmol/L, irrespective of their 10-year CVD risk score. (Where the initial cholesterol reading is ≥ 7.5 mmol/L, the test should be repeated by the accredited pharmacist to ensure that the elevated level is not a false reading. Referral is indicated if the repeat cholesterol value is ≥ 7.5mmol/L).6 4 Julia Hippisley-Cox, J. et al. Predicting cardiovascular risk in England and Wales: prospective derivation and validation of QRISK2. BMJ 2008;336:1475-82 5 Williams.B. et al Guidelines for management of hypertension: report of the fourth working party of the British Hypertension Society, 2004—BHS IV. Journal of Human Hypertension (2004) 18, 139–185. Evidence for NICE CG34 (2006) Management of hypertension in adults in primary care. 6 The total cholesterol threshold for this service is set at 0.5mmol/l below that in NICE guidance to take account of the use of point of care testing. NICE CG71 (2008). Identification and management of familial hypercholesterolaemia. 4 2.2.2 Individuals requiring recall to the community pharmacy Individuals who have a calculated 10-year CVD risk score less than 20% may or may not require recall to the community pharmacy for further tests. The presence or absence of risk factors, as described below, will govern whether an individual requires further assessment. In order to identify whether recall to the pharmacy is required, the diabetes and hypertension filters should be applied. These are described in detail in 2.2.3 and 2.2.4 but are summarised briefly below. Where recall is indicated, individuals should be asked to return to the community pharmacy after 48 hours. This allows patients to prepare for a fasting blood test, which requires that the patient does not eat or drink anything other than plain water for at least 8 hours before the test. The following individuals should be recalled to the community pharmacy for further assessment, based on the results of their initial screen (Phase I of the Health Check): Individuals with a 10-year CVD risk score (QRisk2) less than 20% AND a blood pressure reading ≥ 140/90mmHg but <160/100 mmHg, OR with an isolated systolic BP reading ≥ 140 but < 160 mmHg or an isolated diastolic BP reading ≥ 90mmHg but < 100mmHg. AND / OR Individuals with a 10-year CVD risk score (QRisk2) less than 20% AND a BMI ≥ 30, or ≥ 27.5 if Indian, Pakistani, Bangladeshi, South Asian, other Asian or Chinese ethnic origin. Individuals who are recalled to the community pharmacy after 48 hours will be offered a repeat blood pressure measurement and a fasting blood glucose (FBG) using finger-prick testing. This is discussed further in the subsections below headed Diabetes filter (2.2.3) and Hypertension and Chronic Kidney Disease filter (2.2.4). 2.2.3 Diabetes Filter (please also refer to the patient pathway for diabetes and hypertension, Figure 2, grey shaded area, page 13) The purpose of the diabetes filter is to identify those individuals who are deemed to be at high risk of developing diabetes, based on the presence of risk factors; and to facilitate GP referrals for further assessment where indicated. Risk factors associated with an increased risk of developing diabetes include: High blood pressure (BP) High body mass index (BMI) Individuals, who have a BP reading of 140/90mmHg but <160/100mmHg, OR an isolated systolic BP reading of 140mmHg but <160mmHg or an isolated diastolic BP reading 90mmHg but <100mmHg respectively, will be invited back to the pharmacy for a fasting blood glucose using finger-prick testing, plus a repeat BP measurement (see hypertension filter, section 2.2.4 below). They will be asked to return to the pharmacy after 48 hours for these tests. Individuals with a BMI 30 (or 27.5 if Indian, Pakistani, Bangladeshi, south Asian, other Asian or Chinese ethnic origin) will also be invited back to the pharmacy for a fasting blood glucose test, using finger-prick testing and a repeat BP measurement. They will be asked to return to the pharmacy after 48 hours for these tests. Individuals will need to return for the second assessment 48 hours after the initial assessment, in view of the fact that they are required to have a fasting blood test on the recall visit. Individuals will be given clear verbal and written instructions by the pharmacist, NOT to eat anything, and not to drink anything (except plain water) for 8 to 14 hours (usually overnight) prior to the blood test. 7 Individuals need to have a clear understanding about what a fasting blood test entails, and must be advised that failure to comply with the instructions given will distort the results of the blood test, and may lead to unnecessary GP referrals and subsequent investigations. Diabetes UK. http://www.diabetes.org.uk/Get_involved/Raising-awareness/Silent-Assassincampaign/What-happens-when-you-are-tested-for-diabetes/ 7 5 Individuals who are found to have a FBG level > 3.0 mmol/L but < 5.6 mmol/L do not need a referral to their GP and should be given appropriate lifestyle advice. (See section 2.2.7) Individuals who are found to have a FBG level ≥ 5.6 mmol/L but ≤11.0 mmol/L will be referred to their GP for further assessment and diagnostic tests to exclude or confirm the presence of Impaired Fasting Glucose (IFG), Impaired Glucose Tolerance (IGT) or Diabetes Mellitus (DM).8 Patients should be advised to see their GP within 2 weeks. Pharmacists should be aware that failure to adequately cleanse the finger from which blood is drawn may lead to an artificially high glucose reading. Where individuals are found to have a FBG level ≥ 11.1 mmol/L, the pharmacist should repeat the blood test ensuring that the patient’s and pharmacist’s hands are clean and dry, as failure to adequately cleanse the finger from which blood is drawn may lead to an artificially high glucose reading. Where a reading of ≥11.1 mmol/l is confirmed by a second blood test, the patient should be advised to see their GP within 48 hours. Where the patient complains of feeling unwell, the pharmacist should contact the patient’s GP for further advice. Where the patient is not registered the pharmacist should contact the nearest GP for advice.8 Where the FBG level is ≤3.0mmol/L,9 the pharmacist should carry out the internal quality control procedure (IQC) on the point of care analyser, as a low glucose reading in an otherwise apparently well individual would be unusual. If the results of IQC are normal, re-test the patient’s blood ensuring that the correct quantity of blood is drawn and correctly inserted into the analyser. If on the second test the FBG level remains ≤3.0mmol/l, the pharmacist should contact the patient’s GP for further advice. Where the patient is not registered with a GP, the pharmacists should call the nearest GP for advice. The patient may be given a sugary drink or biscuit if (s)he is feeling unwell. Pharmacists should be aware that there will be a cohort of individuals who do not meet the criteria for the diabetes filter, but who will still be at significant risk of developing diabetes mellitus. These individuals include: Individuals with a first degree relative with diabetes. Individuals with end-organ damage known to be associated with diabetes, for example retinopathy, kidney disease, neuropathy. Women who have had previous gestational diabetes. Individuals with existing medical conditions known to be associated with diabetes, for example, polycystic ovarian syndrome, severe mental health disorders. Individuals currently taking medications known to increase the risk of developing diabetes, for example, oral corticosteroids. Pharmacists should consider the situation of each individual, and offer fasting blood glucose testing where they regard this as being appropriate. 2.2.4 Hypertension and Chronic Kidney Disease Filter (CKD) Filter (please also refer to the patient pathway for hypertension and CKD, Figure 4, p17) High blood pressure is a known risk factor for developing CVD. The purpose of the hypertension and CKD filter is to identify those individuals who may already have established hypertension, and refer them to their GP for further assessment. This further assessment in general practice may include a venous blood test to detect the presence of early CKD changes (serum creatinine and eGFR). Individuals, who have an initial BP reading of 180/110mmHg, OR an isolated systolic or diastolic readings of 180mmHg and 110mmHg respectively, should be referred directly to their GP for a hypertension assessment. Patients should be advised to request to see the GP within 48 hours. Such individuals will need GP-led assessments and are more likely to require pharmacological interventions to manage their blood pressure. Individuals, who have an initial BP reading of 160/100mmHg, OR an isolated systolic or diastolic readings of 160mmHg and 100mmHg respectively, should be referred directly to their GP or Practice 8 Royal Pharmaceutical Society of Great Britain / Diabetes UK (2004) UK Practice Guidance on the Care of People with Diabetes. London: Royal Pharmaceutical Society of Great Britain 9 Patient UK. Emergency Management of Hypoglycaemia. http://www.patient.co.uk/doctor/Emergency-Management-of-Hypoglycaemia.htm 6 Nurse for a hypertension assessment. Patients should be advised to see their GP/Practice Nurse within two weeks. Individuals, who have a BP reading of 140/90mmHg but <160/100mmHg, OR an isolated systolic BP reading of 140mmHg but <160mmHg or an isolated diastolic BP reading 90mmHg but <100mmHg respectively, will be invited back to the community pharmacy for further assessment after 48 hours. Further assessment at recall will include a repeat BP, and a fasting blood glucose test using finger-prick testing. (see Section 2.2.3 above) Individuals will be given clear verbal and written instructions by the pharmacist, NOT to eat anything, and not to drink anything (except plain water) for 8 – 14 hours (usually overnight) prior to the blood test.7 Individuals need to have a clear understanding about what a fasting blood test entails, and must be advised that failure to comply with the instructions given will distort the results of the blood test, and lead to unnecessary GP referrals and subsequent investigations If on repeat measurement, an individual continues to have raised blood pressure (≥ 140/90mmHg, OR with an isolated systolic or diastolic BP reading ≥ 140 or ≥ 90mmHg respectively), they should be referred to their GP or practice nurse for a full hypertension assessment in 4 to 12 weeks (see section 2.2.5 below). If on repeat measurement, an individuals BP is lower than 140/90 mmHg, appropriate lifestyle advice and signposting should be offered in order to reduce their CVD risk. 2.2.5 Individuals with very high or very low blood pressure readings HIGH blood pressure: It is important to recognise and respond appropriately where individuals are found to have very high blood pressure readings, where: Systolic and or diastolic BP 180mmHg or 110mmHg respectively10 (with symptoms) or ≥200/110mmHg without symptoms requires referral to the GP with the patient advised to see the GP within 48 hours BP 160/100mmHg, or systolic or diastolic BP is 160mmHg and 100mmHg but less than 180/110mmHg requires referral to the GP with patient advised to see the GP/Practice nurse within 2 weeks.11 BP ≥ 140/90mmHg or systolic or diastolic BP is 140mmHg and 90mmHg requires recall to the pharmacy after 48 hours for a repeat blood test (see section 2.2.4 above). 12 Where BP remains ≥140/90 but ≤160/100, the patient should be offered lifestyle advice and advised to see their GP in 4 to 12 weeks.13 Common symptoms include: visual disturbances, paralysis or parasthaesia, sudden severe headache, blackouts, seizures and other alarming symptoms. Where the patient meets the criteria above, the pharmacist should call the patient’s GP for further advice. Where the patient is not registered with a GP, the pharmacist should call the nearest GP for advice. LOW blood pressure: Individuals with very low BP readings should be assessed according to whether or not they are experiencing symptoms related to hypotension (low BP). Hypotension usually occurs where the blood pressure is <90/60mmHg. On its own, low blood pressure does not always cause symptoms. If the patient has low blood pressure, and does not have any symptoms, the patient does not require treatment.14 The value at which individuals become symptomatic varies widely, so individuals found to have a BP <90/60mmHg MUST therefore be asked about the presence of symptoms: 10 NICE CG34: Management of hypertension in adults in primary care. NICE Guidance (CG34) recommends that GPs consider drug therapy for patients with persistent BP≥160/100 12 Mild high blood pressure with no other increased risk e.g. high cholesterol) can usually be managed without medication. http://www.patient.co.uk/health/High-Blood-Pressure-A-Summary.htm 13 NICE Guidance (CG34 ) recommends that blood pressure measurements should be taken at monthly intervals to identify hypertension. 14 NHS Clinical Summaries. 11 http://www.cks.nhs.uk/patient_information_leaflet/Blood_pressure_low 7 Cardinal symptoms of hypotension include light-headedness, dizziness, fainting and collapse. Other symptoms include chest pain and unresponsiveness. Hypotension can be life-threatening. Shock occurs when the blood pressure is persistently low; the flow of blood is too low to adequately deliver oxygen and other nutrients to vital organs, such as the heart, kidneys, lungs, liver and brain. This can rapidly lead to organ failure and even death. Asymptomatic hypotension in healthy individuals does not require treatment. Individuals who are found to be hypotensive with any of the symptoms described above (light-headedness, dizziness, fainting), but are still responsive should be positioned to lie on their back with legs lifted, e.g. on a chair. This will increase venous return (blood flow) to the critical organs (heart, lungs, brain). At the same time, the pharmacist should arrange for the individual to be taken to their local A&E department via ambulance, for further assessment. Unresponsive patients, or those with severe symptoms associated with hypotension, should be sent to the local A&E department, via ambulance for further assessment. 2.2.6 Raised cholesterol with no other risk factors All individuals accessing the service will receive a random cholesterol check using finger-prick testing, which will measure total and HDL cholesterol levels. Where the total cholesterol level is found to be raised, the decision about whether an individual needs to be referred to their GP for further assessment and commencement of lipid lowering therapy depends on that individual’s 10-year CVD risk. According to NICE guidelines, lipid lowering therapy is recommended as part of the management strategy for the primary prevention of CVD in individuals who have ≥ 20% 10-year risk of developing CVD. All patients with a CVD risk score ≥ 20% should be referred to their GP. Where the total cholesterol value is ≥ 7.5 mmol/L, or <3.0mmol/L on initial testing, the test should be repeated to ensure that the value is a true reading. Individuals found to have a raised total cholesterol level ≥ 7.5 mmol/L, irrespective of their overall CVD risk, should also be referred to their GP within 2 weeks for further investigations to rule out secondary causes of hypercholesterolaemia and disorders of lipid metabolism.15 Individuals with a raised total cholesterol of 6.5mmol/l to 7.4mmol/l should be advised to see their GP or practice nurse within 4 weeks. Individuals should be given a full explanation as to why they are being referred for investigations in such cases. Individuals with a total cholesterol level > 5.0 mmol/L but < 6.5 mmol/L, with NO other key risk factors for CVD (i.e. high CVD risk score, raised BP and or BMI ) should be offered intensive lifestyle advice about what they can do to reduce their cholesterol level without the need for pharmacological intervention. 2.2.7 Phase III: Lifestyle Advice, Support and Signposting (please also refer to patient pathway for lifestyle advice and signposting, Figure 5, p18) On completion of a NHS Health Check, all individuals, irrespective of their overall CVD risk score or risk factors, should be offered lifestyle advice on managing their cardiovascular risk. Advice should be tailored to each individual’s needs, and the presence or absence of potential cardiovascular risk factors. Lifestyle advice is discussed in more detail below. 2.3 Smoking cessation: 15 Individuals who smoke or who use other forms of tobacco should be offered a discussion with an on-site Level 2 smoking advisor. Referral to smoking cessation services for ongoing support and help with stopping smoking should also be encouraged. Printed information on smoking cessation should be given to all current smokers. NICE CG71 (2008). Identification and management of familial hypercholesterolaemia 8 2.3.1 Sedentary lifestyle: 2.3.2 Overweight and Obesity (BMI >25): 2.3.3 Individuals should be offered advice on the importance of making simple dietary changes in order to lower their cholesterol levels without the need for commencing lipid lowering treatment. Lifestyle advice should focus on an explanation of what cholesterol is, and that reducing cholesterol levels can lower one’s risk of developing CVD. Specific dietary advice is discussed in detail in section 2.3.4 below. Patients with a total cholesterol reading of 6.5 to 7.4mmol/l should be referred to their GP or practice nurse within 4 weeks in addition to lifestyle advice Patients with a total cholesterol reading of 7.5mmol/l and above should be referred to their GP or practice nurse within 2 weeks in addition to lifestyle advice. Healthy eating and dietary advice: 2.3.5 Individuals should be offered general advice on eating healthily (see below). Individuals should be informed about the aim of the Exercise on Referral (EoR) programme, as a means of facilitating and offering ongoing support with weight loss. Referrals to the EoR scheme should be made where individuals are motivated to participate in the scheme, where they meet the inclusion criteria and where they have consented for a referral to be made. Criteria for inclusion in the EoR scheme: Overweight/Obese (BMI >25) Cardiovascular disease Diabetes (type I or II) Depression (mild/moderate) Chronic respiratory disease Musculoskeletal disorders/injuries (must be referred to physiotherapist first) High cholesterol (>5.0mmol/l): 2.3.4 Pharmacists should offer advice regarding the health benefits of keeping active. Individuals should be encouraged to participate in 30 minutes of moderate physical activity, on most days of the week. Explaining to individuals that ‘moderate physical activity’ means any form of exercise that gets you warm, mildly out of breath, and mildy sweaty, e.g. brisk walking, jogging, cycling, swimming. Information on how individuals can increase their physical activity. Pharmacists should reinforce the importance of eating healthily in order to reduce weight and cholesterol levels, and give the following dietary advice. At least 5 portions of fruit and vegetables daily (includes fresh, frozen, canned and dried). The bulk of most meals should be starch based foods, e.g. cereals, wholegrain breads, potatoes, rice, pasta. Reducing intake of fatty foods, e.g. fatty meats, cheese, butter, full-fat milk, cream and fried food; and substituting these products with low fat options, and using mono- or poly-unsaturated oil. Include 2-3 portions of fish per week, at least one of which being ‘oily’ fish, e.g. herring, mackerel, sardine, kippers, salmon, fresh tuna Reducing salt to no more than 6 grams daily Individuals who eat meat should choose lean meat or poultry (chicken) Using sunflower, olive or rapeseed oil for frying Reducing alcohol intake to no more than three to four units (men) or two to three units (women) daily, with at least two or three alcohol-free days each week. Health Trainers Health Trainers have been trained to support people in the local community to make lifestyle changes that can help them improve their health, such as taking up regular exercise, eating a healthier diet, giving up smoking or drinking less alcohol Providing six one-to-one sessions, a Health Trainer will work with you to develop a Personal Health Plan which identifies the areas in your lifestyle that you want to improve and the actions 9 2.3.6 you can take to achieve your goals. Health Trainers focus on four main areas: healthy eating physical activity, smoking and alcohol Provide patients with Health Trainer’s leaflet. Individuals who are resident in Islington, but unregistered with a GP Unregistered individuals should be offered clear advice on how they can register with a GP. The advice should include: Names and locations of local GP practices Contact numbers for Islington PCT Details of the relevant information that may be required in order to register with a GP Verbal and written information should be provided 3. Scope 3.1 Eligibility Criteria for Pharmacists & Pharmacies The Health Check service can only be provided by pharmacists / pharmacies that meet the following eligibility criteria:3.1.1 Community pharmacies are ideally suited to provide this service, particularly as pharmacies are often open at weekends and have extended weekday opening hours beyond 5pm. For provision of this service, pharmacies must be open 6 days per week and on weekdays beyond 5.00pm, unless otherwise agreed with NHS Islington. 3.1.2 There must be at least one pharmacist accredited to undertake health checks present at all times when the pharmacy is open. This will require two pharmacists from each participating pharmacy to be accredited for providing NHS Health Checks. 3.1.3 All pharmacists involved in the delivery of the community pharmacy Health Check service must have an appropriate level of competency to undertake these services. 3.1.4 Pharmacists will be required to attend a 1½ day training programme in Health Checks in community pharmacy prior to service provision, and will also be expected to attend yearly training updates. These training programmes will be provided by Islington PCT and will be reimbursed 3.1.5 Training will include use of the Telehealth CardioPod system and use of Point of Care Testing equipment, in addition to other aspects of the health check. Competency in the use of the POCT and other equipment used in the NHS Health Check will be assessed, and a certificate of completion of training will be issued. Pharmacists will only receive access to the CardioPod system once they have attended training and registered for a username and password. 3.1.6 Pharmacists are should have passed the Centre for Pharmacy Postgraduate training (CPPE) Vascular Risk Focal Point training (or other equivalent) which supports this service. 3.1.7 Pharmacists will be expected to complete level II vulnerable adult safeguarding training when such training is introduced in Islington. 3.1.8 All participating community pharmacies must have a suitable private consultation room on-site, where they can discuss issues relating to the Health Check with individuals in private. A suitable private consultation room is defined as a separate room within the premises with a closed door, where conversations between the pharmacist and client cannot be heard by those outside the room. The room must comply with the usual health and safety and infection control requirements, with appropriate patient access to hand washing facilities. 3.1.9 All community pharmacies must offer smoking cessation services through an on-site trained Level 2 advisor and are expected to offer smoking cessation advice with appropriate referral to patients identified as smokers during the health check. 3.1.10 Community pharmacists must develop and maintain systems for effective communication with local GPs. 10 3.1.11 Pharmacists and any other staff involved in delivery of the Health Check programme must hold a valid Criminal Records Bureau (CRB) check certificate, which is updated every 3 years. 3.1.12 The community pharmacy must have access to the following: Internet access and access to nhs.net email N3 broadband connection Telephone and Fax machine 3.1.13 There are several criteria relating to blood tests that must be met: Pharmacists must demonstrate competency in taking blood tests using the finger-prick method. Pharmacists and other staff involved in taking blood samples, or handling blood products will be vaccinated against Hepatitis B infection, and shown to have made a serological response to the vaccine. This service will be provided by the occupational health department that is responsible for the pharmacist. Pharmacies involved in blood testing will have hand-washing facilities and suitable work surfaces. An infection control policy covering the infection control process, including hand hygiene, standard precautions, sharps safety, clinical waste and cleaning and disinfection of equipment must be in place. Pharmacists involved in blood testing will attend an Infection Control training session as part of the 1½ days training (see section 3.1.6) and be able to demonstrate good clinical practice with regard to the infection control process, including hand hygiene, standard precautions, sharps safety, clinical waste and cleaning and disinfection of equipment, and have access to and knowledge of using blood spillage kits. 3.2 Health Check Inclusion Criteria The NHS Health Check will be provided to individuals who fulfil the following criteria: Age 35 – 74 years inclusive. No known pre-existing CVD (Coronary heart disease, stroke, transient ischaemic attack (TIA)) or chronic kidney disease, diabetes, hypertension or raised cholesterol. Islington resident (whether or not they are registered with an Islington GP). Non-Islington residents who are registered with an Islington GP. Individuals should not have received an NHS Health Check within the previous 2 years, in any setting. Individuals who are not resident in Islington and not registered with an Islington GP will not be eligible for a Health Check under the Islington community pharmacy Health Check service. Pharmacists are able to offer such individuals a Health Check at their own discretion, but should be aware that they will not be paid for this check by Islington PCT and any consumable costs will be recovered by the PCT from the pharmacy. This may not be provided as a private service paid for by the patient. 3.3 Interdependencies This enhanced service for Health Checks in community pharmacy is part of the overall programme of NHS Health Checks that is being developed and rolled out in Islington. Currently, general practitioners are also offering NHS Health Checks to selected patients, under the Local incentive Scheme 2009/10 (CVD and Obesity). Patients at high risk (≥20% CVD risk) are the primary focus of this programme in general practice in 2009/10). It is generally acknowledged that smoking is the single most preventable cause of death and disability in the UK. Cardiovascular disease is the second most common cause of death from smoking in the UK. Pharmacists providing health checks are expected to offer smoking cessation advice and services in line with their Smoking Cessation enhanced service to all patients who are identified as smokers as part of the health check process. 11 4. Patient pathways Figure 1: Delivering a Vascular Risk Assessment and Management Programme (NHS Health Checks) Figure 1 provides a diagrammatic overview of the cardiovascular risk assessment and management process. It should be noted that whilst the national programme targets all individuals aged 40-74 years, a lower threshold of 35 years is being used in Islington, to reflect the higher risk in areas of deprivation and ethnic diversity. Population: 35 – 74 year olds (inclusive) without established cardiovascular disease or diabetes Within General Practice Systematic/Pro-active Outside General Practice Community Pharmacyopportunistic Coronary Heart Disease, Stroke, Hypertension, Diabetes and CKD Risk Assessment Standard Questions Measurements Blood Tests Risk Management Spectrum Source: Putting Prevention First LOW risk MODERATE risk HIGH risk Disease Identified Advice Advice and Assistance Advice and Intervention Existing Clinical Pathways Appropriate feedback and maintenance plan As low risk + Referral to smoking cessation services, Obesity management, Diet and exercise As moderate risk + Pharmacological intervention, GP referral, intensive lifestyle advice Patient managed according to existing clinical pathways for Diabetes, Hypertension, CKD through their GP Patient exits the Health Check programme and is followed up by their GP 12 Figure 2: Patient flowchart for the NHS Health Check Patient details Confirm eligibility and consent Random Finger-prick blood test Cholesterol <6.5mmol/l Cholesterol 6.5-7.4mmol/l Cholesterol ≥7.5mmol/l Blood Pressure ≥180/110 Height and weight, calculate BMI ≥160/100 ≥140/90 <140/90 Repeat BP after 48 hrs BMI ≥30 or ≥27.5 if Asian origin Diabetes and hypertension filter. Complete initial NHS Health Check and recall patient after 48 hours Family History ≥180/110 ≥160/100 ≥140/90 <140/90 Lifestyle Fasting Finger-prick blood test Smoking Diet FBG ≥11.1mmol/l Physical activity FBG 5.6 to <11.1mmol/l FBG 3.0 to 5.6mmol/l FBG ≤3.0mmol/l Repeat test immediately Appropriate advice and referral Alcohol Repeat Blood Pressure Calculate QRisk2 score ≥20% 10% to <20% <10% Advise to see GP within 48 hrs Advise to Advise to Advise to Advise Lifestyle see GP / PN see GP / PN see GP / PN changes to advice to within 2 within 4 in 4 to 12 lifestyle to maintain risk weeksbe made on the weeks weeks with the greatest reduce risk according to the Referral or advice should basis of the risk factor urgency algorithm above 13 Figure 3: Patient Pathway for Diabetes and Hypertenion Case Finding Follows on from Patient Pathway through the Health Check, (see Figure 2) 10-year CVD risk score <20% AND presence of one or more of the following risk factors • BMI ≥ 30 (>27.5 all Asians) • BP ≥ 140/90 but <160/100mmHg or isolated SBP or DBP ≥ 140mmHg and 90mmHg respectively • Other risk factors for DM (1st degree relative with diabetes under age 60years, Gestational DM, PCOS, Long term steroid use) Patient invited to return after 48 hours for Fasting Blood Glucose test and repeat Blood pressure Take patient’s fasting blood glucose and take blood pressure FBG ≤3.0mmol/L and any blood pressure Check analyser and retest, ensuring correct amount of blood is used. If second test ≤3.0mmol/l, advise patient to see GP within 48 hours. FBG ≥3.1mmol/L and ≤5.5mmol/l and BP now <140/90 Lifestyle advice and signposting (Figure 4), FBG ≥5.6mmol/L and ≤11.0mmol/l or BP now <160/100 Lifestyle advice and advise patient to see GP within three to four weeks FBG ≥11.1mmol/L and any blood pressure Check analyser and retest, repeating the complete procedure including hand washing (pharmacist and patient). If after second test FBG≥11.1mmol/l, advise patient to see GP within 48 hours. Blood pressure ≥140/100 but <160/100 and FPG≤5.5mmol/l Lifestyle advice and advise patient to see GP within 12 weeks Blood pressure ≥160/100 and FPG≤11.0mmol/l Lifestyle advice and advise patient to see GP within two weeks Blood pressure ≥180/100 and FPG≤11.0mmol/l Advise patient to see GP within 48 hours. 14 Figure 4: Pathway describing Lifestyle Advice All individuals, irrespective of their CVD risk score should be offered tailored lifestyle advice and signposting to relevant services for further guidance and support with maintaining a healthy lifestyle. This diagram illustrates examples of specific lifestyle advice to be offered to individuals, according to the presence of risk factors If Current Smoker • Explain to individuals that smoking doubles the risk of developing CVD • Offer discussion with on-site Level 2 smoking advisor and referral to smoking cessation services for ongoing support and help with stopping smoking If Sedentary Lifestyle • Advice on the health benefits of keeping active • Encouraging individuals to participate in at least 30 minutes of moderate physical activity, on most days of the week • Moderate physical activity means any form of exercise that gets you warm, mildly out of breath, and mildy sweaty, e.g. brisk walking, jogging, cycling, swimming • Provide information on how individuals can increase their physical activity, local fitness centres, group activities Healthy Eating & Dietary Advice Where BMI > 25 • Healthy eating will help to reduce weight and cholesterol levels. • Providing information on what a healthy diet means (described below) • At least 5 portions of fruit and vegetables daily (includes fresh, frozen, canned and dried produce) • The bulk of most meals should be starch based foods, e.g. cereals, wholegrain breads, potatoes, rice, pasta • Reducing intake of fatty foods, e.g. fatty meats, cheese, butter, full-fat milk, cream, fried food. Switching to low fat, mono- or poly-unsaturated spreads • Include 2-3 portions of fish per week, at least one of which being ‘oily’ fish, e.g. herring, mackerel, sardine, kippers, salmon, fresh tuna • Reducing salt to no more than 6 grams daily • If you eat meat, choose lean meat or poultry • Use sunflower, olive or rapeseed oil for frying • Reducing alcohol intake to no more than 21 units for men and 14 units for women per week • General advise on healthy eating (see box above) • Referral to the Exercise on Referral scheme (EoR) with patient consent • EoR referral criteria (following must be present to be included into the scheme): Obesity (BMI > 25), CVD, Diabetes mellitus, Depression (mild/moderate), Chronic respiratory disease, Musculoskeletal injuries/disorders (must be referred to physiotherapist first) If high Cholesterol (> 5.0 < 7.0 mmol/L) • Reducing cholesterol levels will help to reduce ones risk of developing CVD (See box for dietary advice to help reduce cholesterol levels) Personalised support Personalised support across a range of lifestyle and health topics will be available via the Health Trainers programme from January 2010. There will be a specific referral mechanism and criteria for accessing the health trainers, which will be disseminated to participating community pharmacies once available. 15 5. Service Delivery 5.1 All screening and measurements undertaken as part of the Health Check will be performed by an accredited pharmacist. 5.2 All lifestyle advice, signposting and referral following the Health Check will be performed by an accredited pharmacist. 5.3 This enhanced service will only be commissioned from pharmacies providing the full range of Essential Services as defined by the Pharmacy Contract. 5.4 All pharmacies providing this service should operate a 6-day opening policy (minimum Monday to Friday with extended hours beyond 5.00pm and Saturday morning), with an accredited pharmacist available at all times during these opening hours. (Exceptions to the 6-day opening policy will only be considered where there is no pharmacy available locally that our patients can access). 5.5 Indemnity Pharmacy providers must ensure that appropriate professional indemnity cover is in place. 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. 5.6 Pharmacy providers must adhere to the quality standards and guidelines of their professional body. 5.7 The pharmacy contractor has a duty to ensure that pharmacists involved in the provision of the service have relevant knowledge and are appropriately trained in the operation of the service as demonstrated through Continuing Professional Development (CPD) and Personal Development Plans (PDP). The PCT will monitor this as part of the Contract and Performance management process. 5.8 Pharmacies must maintain and refer to a set of Standard Operating Procedures (SOPs) to cover all the processes involved in the Health Check scheme. The SOPs should be readily available to and understood by all staff involved in the scheme. (Refer to Standard Operating Procedures manual, provided by Islington PCT). 5.9 The pharmacy contractor has a duty to ensure that pharmacists involved in the provision of the service are aware of and operate within locally agreed protocols and within the scope of the services set out in this specification. 5.10 The pharmacy must have adequate facilities and procedures for correct hand washing techniques. Alcohol gel may be used up to five times before washing unless the hands are visibly soiled. 5.11 The pharmacy must allocate a safe place to store equipment and returns and sharps for safe onward disposal. The storage containers provided by the PCT commissioned clinical waste disposal service will be used to store used equipment. 5.12 The pharmacy should clearly display the NHS Islington Health Checks publicity materials and logo, indicating participation in the service. These materials will be provided by NHS Islington. The pharmacy will be required to provide dedicated window space for a window poster to advertise the availability of the service from that pharmacy. 5.13 The pharmacy contractor should ensure that pharmacists adhere to infection control policies and procedures, and ensure that all members of staff involved in the delivery of the service are aware of infection control requirements. The pharmacists should be aware of the risk associated with the handling of used equipment and the correct procedures used to minimise those risks. A needle stick injury procedure and infection control policy should be in place. (Refer to Standard Operating Procedures manual, provided by Islington PCT). 16 5.14 Pharmacists must share relevant information with other health care professionals and agencies, in line with locally determined confidentiality arrangements. 5.15 Pharmacists must ensure that any incidents relating to provision of the service will be reported using their standard incident reporting form and a copy of the incident form will be sent to the PCT within 7 working days of the incident. 6. Referral, Access and Acceptance Criteria 5.16 Geographic coverage and acceptance criteria All Islington residents in the target population are eligible for this service. Individuals who are resident in Islington and identified via this scheme as not being registered with any GP should be given clear information by the pharmacist explaining how to register. These individuals should be actively encouraged to register. Individuals who are not Islington residents will only be eligible for a Health Check in Islington community pharmacies if they are registered with an Islington GP. Pharmacies contracted to provide this service will accept all patients who meet the eligibility criteria. The service will not discriminate on the grounds of ethnicity, sexual orientation or disability. The service will endeavour to meet the needs of patients that have visual or hearing impairment. 5.17 Opportunistic identification and sources of referral Participating pharmacists should identify and invite individuals to take part in a Health Check on an opportunistic basis. GPs and other health care professionals are also able to refer patients to the community pharmacy for a Health Check. Individuals will be able to self-refer into the community pharmacy for a Health Check. 5.18 Onward referral to other services, including General Practice All individuals will be given a print-out of the information gathered during the assessment, including measurements, blood tests results and calculated risk scores. Individuals who are advised to see their GP will also be advised to take this print out with them to their GP appointment. Where onward referral to the patient’s GP is indicated, this will be done electronically, via the dedicated health check software package. A clinical report, giving the results of the assessment and indicating the reason for referral, will be sent via fax to the patient’s GP. Data items include in the clinical report e.g. smoking status, BP etc. will be READ coded by the software provided to facilitate entry into the patient’s clinical record by the general practice. Information regarding the outcome of the assessment for individuals who do not require GP referral will also be transferred to general practice using the same secure method. The PCT will provide participating pharmacies with patient information regarding local services and sources of further information and support with management CVD risk factors. Referral to smoking cessation services: Referral to stop smoking services should be discussed and offered to all current smokers. The pharmacy will have an on-site Level 2 smoking cessation advisor who will mediate this service. NHS Islington will monitor the number of referrals to smoking cessation services. Exercise on referral: Individual who meet the specified criteria described below, should be offered a referral to the Exercise on Referral service. Referrals should be made via fax using the dedicated referral form? Health trainers: Further information will be provided to participating pharmacies once this new service is operational and referral mechanisms and eligibility criteria have been clarified and established. 5.19 Response times The Health Check programme is a while-you-wait service so customers will leave the community pharmacy with their results, wherever practicable. However, there may be some occasions when the dispensing activity is high where patients may be asked to return at a later time. In such cases the Pharmacist must be present at the agreed time. 17 7. Equipment The pharmacy is required to have the following equipment. The equipment will be provided either by the PCT or contracted equipment providers, unless otherwise stated: “Health Check Kit” provided by NHS Islington The equipment listed below will be provided to pharmacies for the purpose of undertaking NHS Health Checks. All equipment provided will remain the property of NHS Islington and may be withdrawn in the case of non-compliance with this Service Level Agreement. “Cardiopod” Touch Screen computer HP Officejet Pro 8000 inkjet printer and cartridges subject to reasonable usage Cholestech LDX analyser including power supply, analyser, optics check cassette, user manual, training video TC/HDL/GLU reagent cassettes MAC internal quality controls Level 1 & 2 External Accredited Quality Assurance scheme (6 samples per year) Heparinised glass tubes and plungers 40 μl Approved Auto Blood Pressure Unit, TM 2655P or better Blood Pressure Cuff with both Small and Large cuffs 200kg scales UC – 321PL Height measurement rod All warranties on equipment provided. Branded folders, information leaflets and signposting information regarding local services; publicity and promotional materials Additional “Health Check Kit” provided by Pharmacies Unistik Extra 3 or Haemolance Lancets Swabs, disposable gloves, plasters, soap dispensers 7.1 The PCT will be responsible for provision of all necessary “Health Check Kit “(as defined above), except where it is indicated that the pharmacy will be responsible for providing equipment. 7.2 The Service Provider must only use the approved equipment provided to them by IPCT for delivery of the NHS Health Checks service. 7.3 The pharmacy provider will be responsible for the maintenance and care of all necessary “Health Check Kit”, including compliance with all warranties. 7.4 All equipment used in the NHS Health Check must comply with MHRA regulations where applicable. 7.5 The pharmacy will ensure that all equipment used is working properly and that the appropriate internal quality control and external quality assurance tests, and calibration, are carried out as 18 described in the Standard Operating Procedure (SOP) manuals and in accordance with the training received. 7.6 The provision of disposables and waste management, including single-use consumables, must comply with environmental regulations and infection control policies. 7.7 The pharmacy will be responsible for ordering ongoing reagent cassettes, heparinised glass tubes, branded folders and information leaflets from the PCT. 7.8 The pharmacy will be responsible for providing and maintaining a suitable N3 broadband connection in the consultation room. 7.9 The equipment may not be used for private services paid for by patients. 7.10 The pharmacy will adhere to PCT guidance on delivery of the NHS Health Checks. 8. Patient and Carer Information 8.1 Wheelchair access Wheelchair and disabled access is provided at Community Pharmacies. 8.2 Access to information for individuals with visual or hearing impairments Audio and Braille versions of any materials provided will not be available at the launch of the programme. It is anticipated that these materials will become available over time. Initially, pharmacists are asked to assist individuals who have such impairments. 8.3 Languages other than English Over time, patient information materials to support delivery of the Health Check programme will be developed in a range of community languages. Initially, where material is only available in English, pharmacists will be expected to assist individuals for whom English is a second language. 9. Quality Assurance 9.1 Point of Care Testing (POCT) Point of Care Testing (POCT, also referred to as Near Patient Testing or NPT) entails the use of analytical equipment, such as patient test kits and analysers, by a trained healthcare operator near to the patient, instead of in a clinical laboratory. Pharmacists will be trained in the use of the POCT equipment, and only those individuals who have had the relevant training will be able to use the equipment. Pharmacies commissioned to provide the Health Check service will all be issued with a manual outlining the Standard Operating Procedures (SOP) for all of the equipment supplied. Training on the use of the POCT equipment will be provided by NHS Islington by a competent trainer. All participating pharmacists will need to demonstrate completion of this training and competence in the use of the POCT equipment, prior to the equipment being put in place. All POCT equipment will be calibrated in accordance with the manufacturer’s guidance. 9.2 Quality Control on the blood analyser machine Internal quality control (IQC): The Optics Check Cassette, used to verify the optical system of the analyser, must be run once daily prior to testing patient samples. External quality control (EQA) (arrangements tbc): A QA solution sample will be sent to the pharmacy for testing on a monthly basis. The results must lie within the established ranges before the equipment can be used to perform tests on individuals accessing the service. Pharmacists are required to record the results of these monthly QC checks, according to the protocol described in the SOPS manual. 19 IQC and EQA requirements are mandatory. Where pharmacies do not adhere to IQC/EQA requirements the service will be withdrawn. 9.3 Quality Control on the blood pressure equipment and weighing scales Pharmacy providers are responsible for ensuring that blood pressure equipment and weighing scales are correctly calibrated at all times. Where there is doubt about the accuracy of the equipment no NHS Health Checks should be undertaken until further advice sought from the manufacturer or NHS Islington. 10. Marketing and Publicity 10.1 Within participating pharmacies All pharmacies offering the NHS Health Check should display the publicity materials provided by NHS Islington. This includes display of the NHS Health Checks poster in a visible location in the pharmacy window. Information leaflets regarding the Health Checks programme will also be provided and should be readily accessible to individuals using the pharmacy service. Pharmacists are expected to identify and pursue opportunities to promote the Health Checks programme and proactively invite individuals to take part in the programme. 10.2 General marketing NHS Islington will support the launch and ongoing delivery of the Health Checks programme in pharmacy through a series of advertising and marketing activities, in order to maximise uptake. 11. Activity 11.1 Activity Record and Invoices The dedicated Telehealth Cardipod system supports automatic recording of all Health Check activity undertaken by individual pharmacists. Each new patient Health Check, as well as further assessments (BP and FPG) undertaken at recall visits, will be captured via the Cardiopod system on a secure server. This information will be accessible to the PCT, and will be used to track activity within individual pharmacies as the basis for payment. Participating pharmacists are required to submit an activity log (printed from the Cardiopod) together with a copy of the Internal Quality Control log and an invoice on a quarterly basis (see section 13, Payments) 12. Payments to pharmacies 12.1 Upfront payments The Service Provider will receive locum cover costs at a rate of £230/full day (£115 half day) to attend the Health Check training programme, run by NHS Islington and any subsequent update training. Costs will be reimbursed for per pharmacist to attend this training. If a pharmacist who is trained to deliver the Health Check service leaves the service provider permanently within 2 years of undergoing the initial training, the service will be suspended until such time as a replacement is accredited. NHS Islington will endeavour to arrange a place on the next available course, although this is not guaranteed. Pharmacies will also receive an annual payment of £100 payable quarterly to cover the provision of gloves, swabs, plasters and lancets. Pharmacists will need to include a claim for £25 to cover these costs on each quarterly invoice/claim form. 12.2 Ongoing payments Pharmacists will be paid £28 for every Health Check completed. An additional payment of £28 will be made for those eligible patients who are recalled to pharmacy for a repeat BP and fasting plasma glucose test. No additional payments will be made if a patient is recalled to the pharmacy but does not attend. 12.3 Printer consumables Replacement cartridges for the printer used for NHS Health Checks will be reimbursed subject to reasonable use. 20 12.4 Payment schedule Payments will be made quarterly on receipt of an activity log printed from the Cardiopod system accompanied by a copy of the Internal Quality Control log and invoice or claim form. Documentation required for payment should be submitted by the 5th day of January, April, July and October. 13. Information Governance 13.1 Patient Consent Patients must give signed specific consent when entering into the programme. Consent is required: To inform the patient’s GP of the test results, and any other relevant information. To allow the pharmacy and NHS Islington to contact the patient and patient’s GP for follow up purposes. To provide anonymised data to NHS Islington for the purposes of service monitoring, evaluation, publication or research. To take a blood sample. 13.2 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.” 16 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.17 All data relating to individuals who receive a Health Check will be held on a secure server, managed by Islington PCT. Pharmacists agree to share information with NHS Islington via remote access. Pharmacists will have a private room within the premises that can be used for consultations. Pharmacies will ensure that all electronic and paper copies of patient records/data held by them relating to this service are held in a secure manner that makes them inaccessible to anyone else except accredited pharmacists. Pharmacists are required to keep any written patient data in respect of this enhanced service in a locked drawer/cupboard. Pharmacies will have N3 broadband connection in consultation room and will transmit information in accordance with NHS Islington Information Governance guidelines. All data will be submitted according to the PCT guidelines. Pharmacists are required to keep a record of clinically significant information from this programme. 13.3 Provision of information Pharmacies will provide patient results to GP surgeries and NHS Islington in accordance with patient consent. 16 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 17 The General Medical Council (GMC) Statement on the duty of confidentiality 21 Pharmacies will provide patient results to the Health Trainers once the health trainer programme is implemented, in accordance with patient consent. 13.4 Protection of Information Service users will be provided with an ID number at their first screening consultation. If an individual is recalled to pharmacy, their existing data will only be retrieved on completion of the following fields: Name Surname Address Postcode Date of Birth Patient Identification Number (PIN) (issued at the first screening check) 14. Monitoring, Evaluation and Service Improvement In line with the Enhanced Service monitoring undertaken by NHS Islington, an indicative quarterly target of 50 consultations by the provider pharmacy has been set by the PCT. The PCT will closely monitor the activity of the provider pharmacy and reserves the right to withdraw the service and remove any “Health Check Kit” (where it has been provided by the PCT) should this target not be achieved. The PCT reserves the right to withdraw this enhanced service immediately if the pharmacy is found not to be meeting its requirements for provision of the Essential Services in Pharmacy Contract after the SLA has commenced. All participating pharmacies will be expected to participate and cooperate with any future audits, surveys or service evaluations of the Health Checks in Community Pharmacy programme by NHS Islington. This service specification will be revised regularly according to need & changing environmental factors, including nationally mandated changes to the NHS Health Checks programme. 15. Duration and Annual review This agreement is intended to remain in place, subject to compliance with sections 1 to 14, from launch in early 2010/11 to March 31st 2012 This service will be reviewed jointly with the pharmacy provider within 6 months of commencement at annually thereafter. 22